Evaluation of Anxiety and Levels of Serum B12, Folate, TSH, Ferritin, and Zinc in Telogen Alopecia Patients with Trichodynia

Dermatology Update on the Challenging Trichodynia

Trichodynia is the sensation of pain in the scalp, which, in most cases, is associated with certain types of alopecia. Despite being a term coined by Rebora back in 1996 to described patients with diffuse alopecia consistent with telogen effluvium, this symptom has currently been reported in other entities. Androgenic alopecia, scarring alopecia, alopecia areata, trichotillomania, and chemotherapy-induced alopecia are common causes of trichodynia. Similarly, its association with psychiatric comorbidities, including depression, anxiety, obsessive-compulsive disorder and somatoform disorders has been reported with a higher prevalence among women. Although its pathogenesis is still to be elucidate, some factors involved are substanceP, psychiatric comorbidities and perifollicular inflammation. Clinically it exhibits pain or discomfort of the scalp, almost always in association with hair los. The sensation of pain can occur throughout the scalp or locally in some specific areas. Diagnosis is clinical and one of exclusion. Regarding treatment, there are no specific therapies for trichodynia. However, the use of botulinum toxinA, antidepressants, neuromodulators, propranolol, topical corticosteroids, oral corticosteroids and topical cannabinoids are therapeutic alternatives that should be taken into consideration. Since treatment of trichodynia is still therapeutically challenging for dermatologists more prospective studies are needed to evaluate new therapies.

Successful Treatment of Refractory Trichodynia With Onabotulinumtoxin-A

Trichodynia is a common symptom, which is characterized by a painful, burning or stinging sensation of the scalp, often in patients presenting with hair loss. It is typically associated with co-morbid psychiatric conditions and remains challenging to treat, with no Food and Drug Administration (FDA) treatments currently available. We herein report the successful use of off-label onabotulinumtoxin-A in treating a patient with trichodynia who has failed conventional therapies.

[Translated article] Sensitive Scalp: Diagnosis and Practical Management

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.

Sensitive Scalp: Diagnosis and Practical Management

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.

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

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.

Presence of Trichodynia Symptoms in Hair Diseases and Related Factors

Background

Trichodynia can be described as a feeling of discomfort in the scalp. Studies on trichodynia also have different data.

Aim

The aim of this study was to investigate the frequency and associated factors of trichodynia.

Methods

A questionnaire was applied to 249 patients who were admitted to the Hair Diseases Unit of Istanbul University, Cerrahpaşa Hospital. We recorded the age, sex, hair loss duration, diagnosis, and whether or not patients had trichodynia symptoms.

Results

Out of a total of 249 patients, 89 patients (35.7%) had trichodynia. We found that the mean age of patients with trichodynia was higher than the mean age of those without trichodynia. Trichodynia was more common in women than in men. In addition, it was more common in the cicatricial alopecia group than the other disease groups.

Discussion

The frequency of trichodynia was significantly higher in women in comparison to that in men. Symptoms of trichodynia were significantly more common in patients with cicatricial alopecia in comparison to that in the other 4 diagnostic categories. There was no significant difference between the 4 diagnostic categories in terms of trichodynia severity.

Trichodynia: a review of the literature

Trichodynia designates a painful sensation on the scalp sometimes reported by patients with hair loss. Its best description dates back to 1960, when Sulzberger et al. (Arch Dermatol 1960; 81: 556-560) reported it in a proportion of women complaining of an unexplained diffuse alopecia. Sulzberger et al.'s remark that trichodynia may also be circumscribed ("spotty") is an important detail missed by most ensuing observers. Women are mostly affected or, at least, more likely to report it. The quality and intensity vary greatly, the "burning" variety being most severe. Whether trichodynia is prevalent in telogen effluvium or it may also be present in androgenetic alopecia remains a crucial question. Hairs shed only from painful sites, and this observation suggests that the severity of trichodynia is directly related to hair shedding and intensity. Trichodynia seems to be related to the release of substance P and is present in alopecia areata. Both observations suggest that peripilar inflammation may be a causative agent.