Trichodynia Revisited

Abstract

Trichodynia refers to the painful sensation of the scalp related to the complaint of hair loss. Originally suggested to be distinguishing for telogen effluvium and related to hair loss activity and follicular inflammation, further studies have found trichodynia to be common in androgenetic alopecia as well and coexisting with psychopathologic findings. The respective studies failed to demonstrate correlations between trichodynia and quantifiable hair loss activity, nor histopathologic evidence for follicular inflammation. A symptomatic scalp is a frequent condition in specific dermatological conditions of the scalp. By definition of exclusion, we are not dealing with trichodynia in these cases. It is conceivable that neuropeptides are key players between the central nervous system and the skin immune and microvascular system. Such mechanisms would explain the noxious effects of both external stimuli and emotional distress in eliciting cutaneous nociception. Since we have begun to understand the diverse etiologies of trichodynia, and a single term does not measure up to this circumstance, it may be wiser to describe the condition depending on the type of scalp sensation and its specific disease association. Further studies are warranted into the neural/endothelial/follicular interactions both in hair growth and shedding and the psychosomatic diseases of the hair and scalp.

Sensitive Scalp and Trichodynia: Epidemiology, Etiopathogenesis, Diagnosis, and Management

“…Topical anesthetic or antipruritic agents are described as therapeutic choices but without description of specific substances [32]. A combination of ketamine 5–10%, amitriptyline 5%, and lidocaine 5% compounded in a Lipoderm cream was published as effective to relieve cutaneous chronic pruritus in different body areas, even in the scalp [45].…”

“…However, the use of creams and heavy lotions can be messy and not pleasant on scalp. Topical corticosteroids are commonly described as an option due to its anti-inflammatory effect, but the long-term use should be avoided as they may induce telangiectasias and skin atrophy [13, 27, 32]. For patients already in use of topical minoxidil, consider switching to oral minoxidil if possible.…”

“…Patients with severe scalp sensitivity or refractory to previous therapies may benefit from oral treatment. Classic drugs in the management of chronic pain and psychodermatological disorders such as tricyclic antidepressants (amitriptyline, doxepin), selective serotonin-norepinephrine reuptake inhibitors (venlafaxine), and anticonvulsants (gabapentin and pregabalin) are used especially in cases of trichodynia [18, 27, 32, 50]. Although common practice, the use in SSc is not supported by clinical studies.…”

“…Trichodynia is more frequent in women [23][24][25], possibly because they are more affected, seek for medical care more often, or have a higher pain perception [19,31]. It is speculated that this condition is associated with perifollicular inflammation, increased expression of substance P in hair follicles, underlying psychiatric disorders, and nutritional deficiencies [19,25,27,32]. It can affect the entire scalp or appear in localized areas, especially in the centroparietal region of the scalp, spontaneously or triggered by combing, drying, and use of accessories (hat, cap, barrettes) [2,13,19].…”

“…For example, Guerra-Tapia et al [13] recommended a transparent fluid gel formulation with sodium hyaluronate from 0.1% to 0.5%, glycerin 5%, hydroxypropyl methylcellulose 1.5%, Phenonip XB 0.6%, tween 20.1%, and purified water. Topical/Local Treatment Topical anesthetic or antipruritic agents are described as therapeutic choices but without description of specific substances [32]. A combination of ketamine 5-10%, amitriptyline 5%, and lidocaine 5% compounded in a Lipoderm cream was published as effective to relieve cutaneous chronic pruritus in different body areas, even in the scalp [45].…”