Scalp itching and burning: A closer look at Lyrica

A closer look at Lyrica

Scalp dysesthesias are a group of conditions whereby affected patients have symptoms in the scalp such as burning and pain. Much to the surprise of the physician and even the patient- the scalp usually looks normal in this group of scalp conditions. I frequently perform a biopsy to ensure any other condition is not being missed.

It’s not clear how exactly these conditions develop. Some studies have suggested that disease in the upper spine (cervical spine) might play a role in some patients, but it’s not a mechanism that applies to everyone with scalp dysesthesia. Some patients have underlying depression and anxiety but again this is not relevant for everyone.

Most patients with scalp dysesthesia feel they have tried nearly every to stop their burning or pain. They have used topical steroids and various shampoos including a variety of anti-dandruff shampoos too. Nothing works.

A variety of options are available to treat scalp dysesthesias including oral and topical gabapentin, Lyrica (pregabalin), amitriptyline, capsaicin and topical ketamine, amitriptyline and lidocIne (TKAL). Lyrica is an anti-seizure medication which is also FDA approved for fibromyalgia, diabetic neuropathy and post herpetic neuralgia. It can benefit some patients with scalp dysesthesia and this is an off label use. It functions by reducing neurotransmitters in nerves such as substance P, glutamate and nortriptyline. When prescribed, I generally start slow with the dose even 50-75 mg a few times per week. 
More common side effects include dizziness and drowsiness. Less common side effects includes visual problems, tremor, fatigue, dry mouth, constipation, weight gain.

Reference

Women with scalp dysesthesia treated with pregabalin.
Sarifakioglu E, et al. Int J Dermatol. 2013.