Exploring the Efficacy and Safety of Interleukin‐23 Inhibitors in Dissecting Cellulitis of the Scalp: A Comprehensive Review

Abstract

ABSTRACTBackgroundDissecting cellulitis of the scalp (DCS), also known as perifolliculitis capitis abscedens et suffodiens or Hoffmann disease, is a rare chronic inflammatory scalp condition with an unknown etiology. The US Food and Drug Administration (FDA) has recently approved multiple interleukin‐23 (IL‐23) inhibitors for chronic‐plaque psoriasis, and their off‐label use has shown promise in treating various dermatological conditions, including DCS. This review assesses the efficacy and safety of IL‐23 inhibitors for DCS, aiming to support potential FDA approval for severe refractory cases.MethodsA comprehensive literature search was conducted in February 2024 using MEDLINE, PUBMED, and Google Scholar with the keywords “Dissecting cellulitis,” “DCS,” “Interleukin‐23 inhibitors,” “IL‐23,” and “Biologics.” The search focused on identifying studies reporting the use of IL‐23 inhibitors in DCS treatment.ResultsThe search identified five cases where IL‐23 inhibitors were used to treat DCS. All patients were male, aged 17–65 years, with multiple comorbidities in four cases, primarily hidradenitis suppurativa and acne conglobata. The IL‐23 inhibitors Risankizumab, Guselkumab, and Tildrakizumab were used, resulting in significant clinical improvement, near‐complete remission, and hair regrowth. Additionally, psychosocial improvements were noted in two cases, with no reported adverse effects.ConclusionIL‐23 inhibitors have shown remarkable efficacy in treating severe DCS, with significant clinical and psychosocial improvements and a favorable safety profile. These findings support the consideration of FDA approval for IL‐23 inhibitors as a treatment option for refractory DCS cases, offering hope for patients with this challenging condition.