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Guerra-Tapia A, González-Guerra E. Sensitive Scalp: Diagnosis and Practical Management. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:141-146. [PMID: 36174707 DOI: 10.1016/j.ad.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/03/2022] [Accepted: 09/09/2022] [Indexed: 02/06/2023] Open
Abstract
Sensitive scalp is sensitive skin located on the scalp. Sensitivity is considered primary in the absence of an associated scalp disorder and secondary when caused by conditions such as psoriasis, seborrheic dermatitis, and atopic dermatitis. The clinical manifestations of primary sensitive scalp are subjective. Common presenting symptoms are burning, itching, trichodynia, and dysesthesia, often coinciding with hair loss. Clinically, the skin appears normal or red. An objective diagnosis based on laboratory or histologic findings is not possible. Triggers may be endogenous (e.g., stress and emotional or psychopathological disturbances) or exogeneous (e.g., topical products and cosmetics). Treatment must be individualized. Options include pimecrolimus, hydration with hyaluronic acid, and mesotherapy with plasma rich in growth factors.
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Starace M, Iorizzo M, Sechi A, Alessandrini AM, Carpanese M, Bruni F, Vara G, Apalla Z, Asz-Sigall D, Barruscotti S, Camacho F, Doche I, Estrada BD, Dhurat R, Gavazzoni MF, Grimalt R, Harries M, Ioannidis D, McMichael A, Melo DF, Oliveira R, Ovcharenko Y, Pirmez R, Ramot Y, Rudnicka L, Shapiro J, Silyuk T, Sinclair R, Tosti A, Vano-Galvan S, Piraccini BM. Trichodynia and telogen effluvium in COVID-19 patients: Results of an international expert opinion survey on diagnosis and management. JAAD Int 2021; 5:11-18. [PMID: 34368790 PMCID: PMC8328568 DOI: 10.1016/j.jdin.2021.07.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The cutaneous manifestations of COVID-19 may be useful disease markers and prognostic indicators. Recently, postinfectious telogen effluvium and trichodynia have also been reported. OBJECTIVE To evaluate the presence of trichodynia and telogen effluvium in patients with COVID-19 and describe their characteristics in relation to the other signs and symptoms of the disease. METHODS Patients with a history of COVID-19 presenting to the clinics of a group of hair experts because of telogen effluvium and/or scalp symptoms were questioned about their hair signs and symptoms in relation to the severity of COVID-19 and associated symptoms. RESULTS Data from 128 patients were collected. Telogen effluvium was observed in 66.3% of the patients and trichodynia in 58.4%. Trichodynia was associated with telogen effluvium in 42.4% of the cases and anosmia and ageusia in 66.1% and 44.1% of the cases, respectively. In majority (62.5%) of the patients, the hair signs and symptoms started within the first month after COVID-19 diagnosis, and in 47.8% of the patients, these started after 12 weeks or more. LIMITATIONS The recruitment of patients in specialized hair clinics, lack of a control group, and lack of recording of patient comorbidities. CONCLUSION The severity of postviral telogen effluvium observed in patients with a history of COVID-19 infection may be influenced by COVID-19 severity. We identified early-onset (<4 weeks) and late-onset (>12 weeks) telogen effluvium.
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Affiliation(s)
- Michela Starace
- Dermatology-IRCCS Policlinico Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Matilde Iorizzo
- Private Dermatology Practice, Lugano/Bellinzona, Switzerland
| | - Andrea Sechi
- Dermatology-IRCCS Policlinico Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Aurora Maria Alessandrini
- Dermatology-IRCCS Policlinico Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Miriam Carpanese
- Dermatology-IRCCS Policlinico Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesca Bruni
- Dermatology-IRCCS Policlinico Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giulio Vara
- Radiology Unit, Policlinico Sant'Orsola, University of Bologna, Bologna, Italy
| | - Zoe Apalla
- Second Department of Dermatology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Stefania Barruscotti
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francisco Camacho
- University of Seville, Medical-Surgical Dermatology Department, University Hospital, Seville, Spain
| | - Isabella Doche
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Bruna Duque Estrada
- Centro de Estudos dos Cabelos, Instituto de Dermatologia Prof. Rubem D Azulay, Rio de Janeiro, Brazil
| | - Rachita Dhurat
- Department of Dermatology, LTM Medical College & Hospital Sion, Mumbai, India
| | | | - Ramon Grimalt
- Facultat de Medicina i Ciencies de la Salut, UIC-Barcelona, Universitat Internacional de Catalunya, Sant Cugat del `Valles, Barcelona, Spain
| | - Matthew Harries
- Department of Dermatology, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Dimitrios Ioannidis
- Department of Dermatology-Venereology, Aristotle University Medical School, Hospital for Skin and Venereal Diseases, Thessaloniki, Greece
| | - Amy McMichael
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Daniel Fernandes Melo
- Department of Dermatology, University of State of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
| | - Rui Oliveira
- Trichology Unit, Dermatology Center CUF Descobertas Hospital, Lisbon, Portugal
| | - Yuliya Ovcharenko
- Department of General and Clinical Immunology and Allergology, V.N. Karazin Kharkiv National University Medical School, Kharkiv, Ukraine
| | - Rodrigo Pirmez
- Centro de Estudos dos Cabelos, Instituto de Dermatologia Prof. Rubem D Azulay, Rio de Janeiro, Brazil
| | - Yuval Ramot
- Department of Dermatology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York City, New York
| | - Tatiana Silyuk
- Hair Treatment and Transplantation Center, Private Practice, Saint Petersburg, Russia
| | | | - Antonella Tosti
- Fredric Brandt Endowed Professor of Dermatology, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Sergio Vano-Galvan
- Dermatology Department, Ramon y Cajal Hospital, IRYCIS, University of Alcala, Madrid, Spain
| | - Bianca Maria Piraccini
- Dermatology-IRCCS Policlinico Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Trüeb RM, Starace MVR, Piraccini BM, Rezende HD, Reis Gavazzoni Dias MF. Trichodynia Revisited. Skin Appendage Disord 2021; 7:449-453. [PMID: 34901175 PMCID: PMC8613582 DOI: 10.1159/000517463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/17/2021] [Indexed: 11/19/2022] Open
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.
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Affiliation(s)
- Ralph M Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb, Wallisellen, Switzerland
| | - Michela V R Starace
- Department of Experimental, Dermatology -IRCCS Policlinico di Sant'Orsola, Diagnostic and Specialty Medicine (DIMES) Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Department of Experimental, Dermatology -IRCCS Policlinico di Sant'Orsola, Diagnostic and Specialty Medicine (DIMES) Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Maria Fernanda Reis Gavazzoni Dias
- Department of Dermatology, Centro de Ciências Médicas, Hospital Universitário Antonia Pedro, Universidade Federal Fluminense, Rio de Janeiro, Brazil
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