Scalp dysaesthesia and lichen simplex chronicus: diagnostic and therapeutic update with literature review

Abstract

Scalp dysaesthesia, considered a variant of the cutaneous dysaesthesia syndrome, is characterized by chronic sensory symptoms, including pruritus, pain, burning and stinging in a well-defined location, without objective findings. Its aetiology is not well elucidated and treatment options are limited, thus it can be challenging and frustrating for both patient and physician. It can be associated with lichen simplex chronicus. In this paper, we review the literature on the pathogenetic factors, diagnostic methods and therapeutic options in the management of scalp dysaesthesia. Dissociation, cervical spine disease and muscle tension seem to be the most important pathogenetic factors. Trichoscopy, reflectance confocal microscopy and biopsy are all helpful for the diagnosis of the disease. Therapies include high-potency topical or intralesional corticosteroids, capsaicin and topical anaesthetics, sedative antihistamines, tricyclic antidepressants, transcutaneous electric nerve stimulation, botulinum toxin and vitamin B12.

Trichoscopic Diagnosis and Management of a Case of Scalp Dysesthesia with Lichen Simplex Chronicus

“…Even though the etiology was not completely elucidated, various neurogenic and psychogenic factors were proposed to trigger SD. [ 1 2 3 ] Cervical spine disease at the level of C5-C6 is the most frequent neurogenic cause of SD. [ 4 ] It was hypothesized that the chronic tension placed on occipitofrontalis muscle and scalp aponeurosis lead to unpleasant sensation over the scalp similar to the pathogenesis of notalgia paresthetica.…”

Scalp dysesthesia: a neuropathic phenomenon

“…These drugs may also treat pruritus, as SSRI medications paroxetine, sertraline, and fluoxetine have been shown to attenuate multiple types of itch, including those psychogenic in origin 64 . Additionally, sertraline specifically is recommended as a treatment for scalp dysesthesias 2 . A combination of antidepressants with pimozide, a neuroleptic agent, also improves dysesthesia in patients with psychiatric comorbidities 49,50 …”

“…64 Additionally, sertraline specifically is recommended as a treatment for scalp dysesthesias. 2 A combination of antidepressants with pimozide, a neuroleptic agent, also improves dysesthesia in patients with psychiatric comorbidities. 49,50…”

“…Scalp dysesthesia is caused by multiple etiologies that can be divided into two broad categories, psychogenic and neuropathic 1 . Here, we focus mainly on the neuropathic causes, pathology, and treatment of itch in the scalp, which are underrecognized, understudied, and commonly misdiagnosed 2 …”

“…1 Here, we focus mainly on the neuropathic causes, pathology, and treatment of itch in the scalp, which are underrecognized, understudied, and commonly misdiagnosed. 2 Neuropathic itch is related to pathology located at any point of the afferent pathway of the nervous system. Patients experience neuropathic itch in the absence of, or out of proportion to, external stimuli.…”