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SCALP DYSESTHESIAS: Misunderstood, Misdiagnosed, and Poorly Managed

SCALP DYSESTHESIAS: 

It comes as a surprise that some patients have a scalp that hurts, burns, stings or itches - even when it looks perfectly fine.  Many of these patients have what are called 'scalp dyesthesias.' These conditions are often misdiagnosed.  

Scalp dysesthesia was first presented in the world medical literature by Hoss and Segal in 1998 as a  a syndrome characterized by itching, burning, stinging, or pain of the scalp - when other physical findings in the scalp are lacking.  In their original case series description of 11 patients - 7 had symptoms which were worsened by stress, 5 patients had at least 1 known psychiatric disorder (depressive type symptoms, anxiety, somatization). Interestingly,  9 patients had symptom improvement with low-dose antidepressant treatment.

 

In 2013, Thornberry and colleagues from the University of Pittsburg examined the medical records or 15 women with scalp dysesthesia. 14 of these women had cervical spine disease. This included problems in the C5-C6 region of the cervical spine, anterolisthesis, osteophytic spurring, lordosis, kyphosis, and nerve root impingement. Treatment with gabapentin (topical or oral) had been recommended. 4 of the 7 patients that they had long term data on noted improvement in symptoms when taking gabapentin. 

 

COMMENT

The scalp dysesthesias remain an area of dermatology that is poorly researched and poorly understood. We are moving towards an understanding that these are complex disorders with multiple reasons for their cause. Yes, some patients with scalp dysthesisas do have underlying depression and anxiety that is contributing to their symptoms, but not all such patients. In a similar light, disease in the cervical spine may contribute to a subset of patients with scalp dysestheias - but the actual proportion is unknown. We have a lot more to learn about these conditions, both in terms of cause and treatment. 

 

REFERENCE

Hoss and Segal. Scalp dysesthesia. Arch Dermatol. 1998 Mar;134(3):327-30.

Thornsberry and English. Scalp dysesthesia related to cervical spine disease. JAMA Dermatol. 2013 Feb;149(2):200-3.

 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Anisotrichosis in Female AGA

Variation in Follicular Caliber

Variation in size of follicles is typical of androgenetic alopecia (hereditary thinning). This has been termed "anisotrichosis." In this picture of a female patient with androgenetic hair loss, it can be seen that some hairs are thick and some are much thinner. The decrease in caliber is due in part to a decease in the size of the dermal papilla (a part of the hair follicle).

Reference
Sewell L et al Anisotrichosis: A novel term to describe pattern alopecia. J Am Acad Dermatol 2007; 56: 856. 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Dry Shampoos

Dry shampoos are becoming increasingly popular. These products, whether they are powders or sprays help absorb oils and keep the hair fresh. Many people with hair loss love these products as they limit the amount of shampooing they feel they need - and therefore limit the emotional burden of seeing excess hair in the shower and drain. One of the risks of dry shampooing and the "no poo" (no shampoo) movement in general is the development of the red itchy flaky scalp condition known as seborrheic dermatitis (shown here). Patients with seborrheic dermatitis require anti yeast agents to control their scalp inflammation. These are typically available in shampoo form and require the patient to shampoo.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Hair loss at age 50

I posted an answer to a new question on Realself.com

Hair loss at age 50


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Levia for FFA

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Levia for FFA


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Tapered Hair in AA

Alopecia areata (AA) is an autoimmune condition. Inflammation accumulates in and around the bottom of hair follicles leading to many changes to hairs. These changes can best be seen when highly magnified or using a dermatoscope. Dermatoscopic appearance of AA includes broken hairs, black dots, tapered hairs, vellus hairs, exclamation mark hairs, yellow dots and coudability hairs.

This picture shows a tapered hair. It is long but tapers to a very thin strand just before entering the scalp. Compare this to neighbouring normal appearing hairs which as fairly wide as they enter the scalp.

Tapered hairs provide clues that inflammation is present in the skin and further hair loss is likely to occur.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Biofiber hair

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Biofiber hair


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Frontal Fibrosing Alopecia

Frontal fibrosing alopecia (FFA) is a type of "scarring alopecia" that affects women. There is permanent hair loss along the frontal hairline. Other areas of hair loss include the top or back of the scalp, eyebrows, eyelashes, eyebrows and body hair.

Examination of the scalp shows alterations in the frontal hairline. Scattered isolated hairs are seen in the forehead and these are called "lonely hairs." Thinning of the skin is common in FFA and leads to veins being easy to see.

The cause of FFA is not known although hormonal abnormalities may be present in some women with FFA. The 5 alpha reductase inhibitors appear to be the most effect treatment and are frequently used in combination with treatments such as topical steroids, steroid injections and oral doxycycline or hydroxychloroquine.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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MPB or TE

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MPB or TE


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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