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.
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.
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