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Trichodynia, Scalp Dysesthesia, Symptomatic Scalp (Scalp Pain, Tight Scalp)

posted by HairSite Homepage E-mail, 07.06.2008, 15:34

Reposted from the Men's Forum on HairSite. A couple of good articles for those who experience intense scalp sensation, scalp pain, tingling etc.


This condition is known as trichodynia (sometimes referred to as scalp dysesthesia or symptomatic scalp). Trichodynia is defined as abnormal scalp sensations (tingling, burning, pain, and sometimes itching) WITHOUT any apparent cause (IMPORTANT: by definition, this means that no scalp disease is present -- no seb derm, no psoriasis, etc -- the scalp is completely normal on examination). The cause is unknown; however, upregulation of substance P, an important neuropeptide, occurs around affected hair follicles, which could play a role in this condition.

Trichodynia is often associated with various forms of hair loss, including pattern baldness and chronic telogen effluvium. Since it is associated with several forms of hair loss, some of which are independent of androgens, the cause is not likely to be androgens themselves. Rather, it is likely a generic mechanism common to several forms of hair loss...probably a complex, neuroendocrine process. Low-dose antidepressants are effective (particularly the tricyclics).

I posted several refernces below, as well as some key abstracts.


1) Substance P (SP) in innervated and non-innervated blood vessels in the skin of patients with symptomatic scalp. Exp Dermatol. 1999 Aug;8(4):344-5.

2) Trichodynia. Hautarzt. 1997 Dec;48(12):877-80.

3) Painful, itchy, symptomatic scalp. J Cutan Med Surg. 1999 Nov;3 Suppl 3:S41-4.

4) Telogen effluvium and trichodynia. Dermatology. 1998;196(3):374-5.

5) Trichodynia. Dermatology. 1998;196(3):374.

6) Trichodynia. Dermatology. 1996;192(3):292-3.

Int J Dermatol. 2003 Sep;42(9):691-3.

The presence of trichodynia in patients with telogen effluvium and androgenetic alopecia.

Kivanc-Altunay I, Savas C, Gokdemir G, Koslu A, Ayaydin EB.

Department of Dermatology, Sisli Etfal Research and Training Hospital, Istanbul, Turkey. derma14@turk.net

BACKGROUND: Trichodynia refers to pain, discomfort, and/or paresthesia in the skin of the scalp or the hair. There may be an associated psychologic comorbidity. Although androgenetic alopecia (AGA) and telogen effluvium (TE) are different entities in terms of pathogenesis, etiology, and clinical picture, both may be influenced by psychologic stress and may be the cause of secondary stress. AIMS: To investigate the presence of trichodynia in patients with TE and AGA and to evaluate psychologic comorbidity in patients with trichodynia. MATERIALS AND METHODS: A total of 248 patients (153 females, 95 males), presenting with hair loss due to either TE or AGA, were enrolled in this study. The prevalence of trichodynia in these two groups was compared with that in controls (n = 184). In addition, psychiatric evaluation was performed in 25 patients with trichodynia (13 females, 12 males) and in 25 controls (16 females, nine males) without alopecia and trichodynia by a psychiatrist; Diagnostic and Statistical Manual of Mental Disorders (DSM)IV criteria were used for the assessment. RESULTS: Trichodynia was found in 72 patients (29%) with hair loss and in six controls (3.3%; P < 0.0001); 25 of the 72 patients with trichodynia underwent psychiatric evaluation and 19 of the 25 patients were found to have psychopathologic signs (76%). In the control group, only five patients had psychopathologic signs (20%; P = 0.0004). Of those with hair loss, trichodynia was more frequent in the TE group than in the AGA group (P < 0.0071). CONCLUSIONS: Trichodynia is a common symptom in patients with TE and AGA, and often coexists with psychopathologic findings, including depression, obsessive personality disorder, and anxiety.

PMID: 12956679

Arch Dermatol. 1998 Mar;134(3):327-30.

Scalp dysesthesia.

Hoss D, Segal S.

Department of Dermatology, University of Connecticut Health Center, Farmington 06030, USA.

BACKGROUND: Cutaneous dysesthesia syndrome is a disorder characterized by chronic cutaneous symptoms without objective findings. Patients complain of burning, stinging, or itching, which is often triggered or exacerbated by psychological or physical stress. These symptoms may be manifestations of an underlying psychiatric disorder or may represent a type of chronic pain syndrome. OBSERVATIONS: Eleven women presented with chronic severe pain and/or pruritus of the scalp only without objective physical findings, a condition we term "scalp dysesthesia." Five women described pain, stinging, or burning only; 4 women complained of pain and pruritus; and 2 women reported pruritus only. The patients ranged in age from 36 to 70 years. The duration of symptoms ranged from 9 months to 7 years. Five women had physician-diagnosed psychiatric disorders, including dysthymic disorder, generalized anxiety, and somatization. Seven women reported that stress triggers or exacerbates their symptoms. Eight women experienced improvement or complete resolution of symptoms with treatment with low-dose doxepin hydrochloride or amitriptyline hydrochloride. One patient responded completely to treatment with sertraline and hydroxyzine hydrochloride but then experienced a relapse. CONCLUSIONS: We describe 11 patients with a new syndrome that we term scalp dysesthesia. Of 11 patients, 9 benefited from treatment with low doses of antidepressants.

PMID: 9521031

Dermatology. 2002;205(4):374-7.

Hair pain (trichodynia): frequency and relationship to hair loss and patient gender.

Willimann B, Trueb RM.

Department of Dermatology, University Hospital of Zurich, Switzerland.

BACKGROUND: Patients complaining of hair loss frequently claim that their hair has become painful. OBJECTIVE AND METHODS: The aim of the study was to evaluate the frequency of this phenomenon and its relationship to hair loss. Patients seeking advice for hair loss either spontaneously reported or were questioned about painful sensations of the scalp. Hair loss activity was quantified by a hair pull, daily count and wash test. Telogen percentage was obtained by a hair pluck. The scalp surface was examined by dermatoscopy. RESULTS: Of 403 examined patients, 20% of women and 9% of men reported hair pain, irrespective of the cause and activity of hair loss. A minority presented scalp telangiectasia. This strongly correlated with hair pain. CONCLUSIONS: Hair pain (trichodynia) affects a significant proportion of patients complaining of hair loss and may increase the anxiety. The symptom neither allows discrimination of the cause nor correlates with the activity of hair loss. A higher prevalence of female patients might be connected to gender-related differences in pain perception in relation to anxiety. The role of vasoactive neuropeptides in the interaction between the central nervous system and skin reactivity is discussed. In the absence of any correlation with quantitative parameters of hair loss or specific morphologic changes of the scalp, management remains empiric and tailored to the individual. Copyright 2002 S. Karger AG, Basel

PMID: 12444334

Hautarzt. 2000 Dec;51(12):899-905.

Trueb RM.

Dermatologische Klinik, Universitatsspital Zurich, 8091 Zurich, Schweiz. ramitru@derm.unizh.ch

In approximately 30% of cases of chronic diffuse loss of scalp hair with a duration of at least 6 months, no underlying abnormality can be found. Typically this occurs in women, starting abruptly without a recognizable initiating factor, and involving the entire scalp area with increased shedding of telogen hair. With the exception of bitemporal recession, hair thinning is usually discrete, and contrasts to the great emotional overtones in this situation. This may initially lead to the differential diagnosis of psychogenic pseudo effluvium. Due to synchronization of the hair cycle, the amount of shed hair is greater than that in androgenetic alopecia, while miniaturized hairs are not a feature of the disorder. Overlap with androgenetic alopecia and/or psychogeneic pseudo effluvium is not uncommon. Scalp dysesthesia or a sensation of "pain in the hair" (trichodynia) is an accompanying symptom in a significant proportion of cases, and correlates better with emotional upset than with actual hair loss. Current therapeutic recommendations are pragmatic, and based on both experimental observations of the sheep wool industry and clinical experience. They include the use of L-cystine-containing oral preparations and of corticosteroids. Further investigation into the molecular controls of the hair cycle are required to find a more specific form of therapy, for which the expense and risk-benefit ratio seem appropriate for the treatment of this benign condition.

Publication Types:
Review, Tutorial

PMID: 11189837

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