OSCE — Dissecting cellulitis of the scalp (perifolliculitis capitis)

Brief (to candidate)

You will assess a patient with a presentation consistent with Dissecting cellulitis of the scalp (perifolliculitis capitis).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Dissecting cellulitis of the scalp (DCS) is a chronic, progressive, suppurative follicular disorder producing painful boggy nodules, abscesses, and interconnected sinus tracts on the scalp vertex and occiput, ultimately causing scarring alopecia. It is part of the follicular occlusion tetrad (with hidradenitis suppurativa, acne conglobata, and pilonidal sinus) and predominantly affects young Black men aged 20 to 40. First-line therapy is oral tetracyclines; escalation is with rifampicin plus clindamycin, oral isotretinoin, anti-TNF biologics (adalimumab), or surgical excision with grafting for refractory disease.

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.^[2]