Burning scalp syndrome

Some individuals who develop telogen effluvium, or other conditions where an increase in telogen hair follicles develops (as for androgenetic alopecia and alopecia areata), report painful burning sensations in association with the hair loss. Until recently this problem was not officially identified by dermatologists. Publications from the late 1990s have named these burning and pain sensations as "scalp dysesthesia", "burning scalp syndrome", or "trichodynia".

The cause of burning scalp syndrome is not understood and has not been researched in any detail. However, there is some preliminary research and much speculation that changes in the production and activity of neuropeptides in the skin may play a role. There is some evidence of an interaction between neuropeptides produced by nerve cells in the skin and the hair follicle cycle. In particular, skin and hair follicle concentrations of a factor called "substance P" fluctuate in tune with the growth and rest of hair follicles. Substance P can initiate pain sensations. In principle, it may be that as hair follicles are adversely affected in a hair loss disease and more of the follicles enter a telogen resting state the levels of substance P or similar neuropeptides in the skin significantly increase. The result is a painful sensation as hair loss progresses.

Alternatively, and more simply, hair loss can involve increased inflammatory cell activity, which can be fairly common in androgenetic alopecia, but much less so in telogen effluvium. A third explanation for burning scalp syndrome rests has been suggested based on an underlying psychiatric disorder in the affected individual.

Burning scalp syndrome is apparently treated by some dermatologists with tricyclic antidepressants. While these are typically used to treat depression and other similar disorders, it has also been shown that antidepressant drugs reduce substance P production. Thus anti depressants may work by directly reducing substance P levels in the skin and in so doing reduce localized pain sensations. Other suggested treatments have included non-irritating shampoos, topical antipruritic or anesthetic agents, topical capsaicin, and corticosteroids.

Burning scalp syndrome references

• Willimann B, Trueb RM. Hair pain (trichodynia): frequency and relationship to hair loss and patient gender. Dermatology. 2002;205(4):374-7.
• Arck PC, Handjiski B, Hagen E, Joachim R, Klapp BF, Paus R. Indications for a 'brain-hair follicle axis (BHA)': inhibition of keratinocyte proliferation and up-regulation of keratinocyte apoptosis in telogen hair follicles by stress and substance P. FASEB J. 2001 Nov;15(13):2536-8.
• Trueb RM. [Idiopathic chronic telegon effluvium in the woman] Hautarzt. 2000 Dec;51(12):899-905.
• Hoss D, Segal S. Scalp dysesthesia. Arch Dermatol. 1998 Mar;134(3):327-30.
• Ericson M, Gabrielson A, Worel S, Lee WS, Hordinsky MK. 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.
• Kramer MS, Cutler N, Feighner J, Shrivastava R, Carman J, et al. Distinct mechanism for antidepressant activity by blockade of central substance P receptors. Science. 1998 Sep 11;281(5383):1640-5.
• Trueb RM. Telogen effluvium and trichodynia. Dermatology. 1998;196(3):374-5.
• Grimalt R, Ferrando J, Grimalt F. Trichodynia. Dermatology. 1998;196(3):374.
• Trueb RM. [Trichodynia] Hautarzt. 1997 Dec;48(12):877-80.
• Rebora A, Semino MT, Guarrera M. Trichodynia. Dermatology. 1996;192(3):292-3.
• Hua AS, Thomas GW, Kincaid-Smith P. Scalp tingling in patients on labetalol. Lancet. 1977 Aug 6;2(8032):295.