Evidence checked 26 October 2026. General information, not a personal diagnosis.
What are these painful, boggy lumps on my scalp?
If you have tender lumps on the top or back of your scalp that join together, leak pus and leave bald patches, one possible cause is dissecting cellulitis of the scalp, also called perifolliculitis capitis abscedens et suffodiens. The name is misleading. It is mainly an inflammatory condition of the hair follicles, and without effective treatment it can scar them permanently [1][2].
Painful lumps or discharge on your scalp? Early assessment is important because inflammation can lead to permanent scarring. Ask about a consultation, email team@thewellnesslondon.com or call 020 3951 3429. Assessment comes before any decision about treatment.
At a glance
- It is a rare, chronic, relapsing scalp condition. Painful nodules and abscesses link beneath the skin through sinus tracts [1].
- It is most often reported in men aged 18 to 40 and is more common in skin of colour [1].
- Hair is typically lost from the top of the lumps and kept in the valleys between them. Late lesions scar [1].
- UK primary care guidance advises urgent referral to secondary care [1].
- PRP is not a treatment for it. Nothing on this page suggests otherwise.
What does dissecting cellulitis look like?
The Primary Care Dermatology Society describes pustules that group into firm nodules of 1 to 4 cm, which later soften. Confluent nodules form ridges in an irregular, brain-like pattern. Pressing one end can push pus out of the other, and the discharge is often foul-smelling. The crown and back of the head are the most common sites, though the whole scalp can be involved [1].
It sometimes occurs alongside acne or hidradenitis suppurativa [1]. Dermatology literature groups it with these and pilonidal sinus as the follicular occlusion tetrad [2].
Is it an infection?
Not primarily. A 2022 review describes it as a chronic, relapsing inflammatory condition in which sterile pustules and nodules come first, and bacteria can join in later [2]. In practice, that means picking or squeezing the lumps is unlikely to help, and a course of antibiotics that works for a while and then fails is characteristic of the condition.
Fungal scalp infection can look similar, so UK primary care guidance says cultures of pus and of the hair follicles should always be done to rule it out. A skin biopsy is only needed when the diagnosis is uncertain [1].
How is it treated?
The evidence is thin. A systematic review of treatment for refractory disease identified 57 articles, 53 of them case studies or case series, and its authors state that randomised trials are needed [3].
What UK guidance and the literature describe:
- First steps. An oral antibiotic and an antiseptic wash while referral is arranged [1].
- Specialist treatment. Secondary care uses a prescription-only regimen intended to induce remission and protect follicles not yet scarred. Localised disease may be treated with steroid injections into the lesions [1].
- Treatment-resistant disease. Reports describe prescription medicines, biologic medicines, laser treatment and surgery, but small, uncontrolled studies cannot reliably tell us which works best [3]. PCDS lists biologic therapy and wide excision with grafting for recalcitrant cases [1].
Treatment decisions depend on disease activity, other health conditions and future plans, and belong with a prescriber who can monitor you. We do not publish a one-size plan.
Does PRP work for dissecting cellulitis?
We found no evidence supporting it in the sources reviewed here [1][2][3]. Dissecting cellulitis is an active inflammatory process that can destroy follicles, and the priority is to control inflammation and prevent scarring. PRP is not a cure for active or scarred disease, and it cannot regrow hair from scarred follicles.
When should I get this checked?
Soon. Seek assessment if you have painful scalp lumps that are growing, joining or discharging, or areas where hair has stopped growing and the skin looks smooth. Seek urgent same-day medical care if you have fever, spreading redness, severe pain or feel unwell.
What can I do in the meantime?
- Do not squeeze, pick or try to drain the lumps.
- Avoid tight hats and helmets that rub inflamed areas.
- Wash gently.
- Photograph the scalp every one to two weeks so changes are easy to show a doctor.
- Do not stop any prescribed treatment without advice from the prescriber.
Next step
To discuss your symptoms, ask about a consultation, email team@thewellnesslondon.com or call 020 3951 3429. Assessment comes before any decision about treatment.
Frequently asked questions
Is dissecting cellulitis contagious? It is an inflammatory condition of the hair follicles, not an infection you catch from someone else [2].
Will my hair grow back? Follicles that are inflamed but not yet scarred may recover with effective treatment. Scarred follicles do not regrow hair [1].
Is it the same as hidradenitis suppurativa? They are different conditions in the same family, and some people have both [1][2].
Does PRP cure it? No.
This article is general information and does not replace personal medical advice. Individual outcomes vary.
References
- Primary Care Dermatology Society. Dissecting cellulitis (clinical guidance, updated 21 Nov 2021). https://www.pcds.org.uk/clinical-guidance/dissecting-cellulitis-2
- Nussbaum D, Desai S, Nelson K, Saardi K, Friedman A. An up-to-date approach to the management of dissecting cellulitis. J Drugs Dermatol. 2022 (published online 27 Jun 2022). https://jddonline.com/articles/an-up-to-date-approach-to-the-management-of-dissecting-cellulitis-S1545961622P0800X
- Thomas J, Aguh C. Approach to treatment of refractory dissecting cellulitis of the scalp: a systematic review. J Dermatolog Treat. 2021;32(2). https://www.tandfonline.com/doi/10.1080/09546634.2019.1642441