What causes scalp burning?

SCALP BURNING: WHAT ARE THE CAUSES?

For some patients, scalp burning is a short term symptom. Rarely though it is a frustrating chronic condition. Some patients have isolated scalp burning whereas others have both itching and burning and some have scalp itching, burning and pain. There are many causes of scalp burning ways to classify scalp burning, including those that show visible changes on the scalp and those that do not.  I like to think about burning in 6 simple categories, that I simply call the 6 D’s

1.  Diseases/Disorders of the scalp

Anyone with scalp burning needs a thorough examination to evaluate for underlying scalp disease. A variety of inflammatory scalp disorders can trigger burning including scalp psoriasis, seborrheic dermatitis, scarring alopecia, dermatomyositis, tinea capitis, sunburns, irritant and allergic contact dermatitis. Common hair loss conditions such as androgenetic alopecia, telogen effluvium and scarring alopecia are also associated with burning in some cases.

2.  Dysesthesias

The scalp dysesthesias, as described by Hoss and Segal in 1998, are a group of conditions that give physical symptoms in the scalp without any other unusual findings at the time of examination (normal scalp examination). In addition to scalp burning, many patients with scalp dysesthesias have itching and pain.

The cause of scalp dysesthesias is not clear. One study (reference below) suggested that a high proportion of women with scalp dysesthesias had cervical spine disease. It seems that patients worsen with stress and improve with anti-depressants (venlafaxine, amitrytyline). Many respond to topical or oral gabapentin.

The burning scalp syndrome (similar to burning mouth syndrome) is a variant of scalp dysesthesia. Sensitive scalp syndrome may also be as well.

3. Depression and Other Psychological Issues.

There is a well known relationship between the brain and the skin and this has been referred to as the 'brain-skin' axis. Stressful life events are a well known trigger to scalp burning. Burning is more common in patients with a host of psychological and psychiatric diagnoses including depression, anxiety, post traumatic stress disorder, schizophrenia.

4. Drugs

Drugs can trigger scalp burning, both topical drugs and oral medications. Topical medications containing alcohol are frequent triggers or scalp burning. Topical calcipotriol, topical steroids, and a host of anti-dandruff shampoos can trigger burning. Oral medications, including cyclophosphamide can trigger scalp burning.

5.  Damaged Nerves and Small fiber neuropathies

Scalp burning may be a result of damage to nerves. As mentioned above, cervical spine disease may be one such condition. But diabetes, multiple sclerosis, and stroke can all give scalp symptoms.

Many issues affecting the tiny nerves of the scalp can cause scalp burning. This is seen in many of the autoimmune diseases including Sjogren’s syndrome.

6. Deprivation of Sleep

Sleep deprivation has been associated with a range of cutaneous symptoms including scalp burning.

REFERENCE

Thornsberry L et al. Scalp Dysesthesia Related to Cervical Spine Disease JAMA Dermatol. 2013;149(2)