Approach to the Treatment of Scalp Dysesthesias

The Treatment of Scalp Dysethesia.

Scalp Dysesthesias are a group of scalp disorders whereby patients feel a variety of scalp syptoms such as itching, burning, pain, tingling in the absence of any obvious scalp cause. The concept of scalp dysesthesia was first presented in the world medical literature by Hoss and Segal in 1998. Scalp dysesthesias are often misdiagnosed.  

Scalp Dysesthesia: Towards Finding a Cause

The cause of scalp dysesthesias remain to be fully worked out. A variety of medical and dermatologic issues need to be completely ruled out. These include primary scalp disease of course (various types of, early scarring alopecia, contact dermatitis,etc). Generally speaking a true primary scalp dysesthesia does not have any physical findings on the scalp so there is no evidence of these diseases.


Depression and Anxiety in Scalp Dysesthesia.

In the original Hoss and Segal 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.


Cervical Spine Disease in Scalp Dysesthesias

 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 gabapetin. 


Scalp Dysesthesia: Towards Finding a Treatment

My approach to treating scalp dysesthesias has been discussed in other articles but will be stated briefly here again.

1. The first step begins with careful dermatoscopic/trichoscopic examination by a dermatologist ensuring that there is no primary scalp disease that could explain the symptoms. In some cases, this will require the use of a scalp biopsy to exclude an inflammatory scalp disorder.

2. In the case of a non contributory biopsy or normal scalp examination, a trial of topical corticosteroids and/or topical antidandruff type shampoos may be considered to evaluate the effect of these treatments on the symptoms. Most primary scalp dysesthsias are not helped by these agents.

3. Evaluation of neurological and psychiatric and rheumatological history should be undertaking by the physician. At this point, I do consider it important that the physician screen for neurological, rheumatological and psychiatric disease. It is important to evaluate a variety of factors such as headaches, eye symptoms, symptoms radiating into the hands, joint pain, (especially hands), neck symptoms, depression symptoms, anxiety symptoms, history of previous neck injury.

4. Referral to specialists in neurologic, rheumatology, psychiatry may be considered in some cases.

5. An X ray of the cervical spine or MRI may be considered in some cases. Generally speaking I may order a cervical spin x ray in some cases. However, leave this to the specialists to consider the utility of an MRI .

6. Depending on the above findings, we may consider initiation of scalp exercises or a trial of pharmacological agents such as gabapentin, Lyrica, amitriptyline, antidepressants to address the scalp dysesthesia.. These require at least 2 months of use to get a sense if they truly impact the scalp dysesthesia.

GABAPENTIN

LYRICA

AMITRIPTYLINE

7. Referral to a phsiotherapist may be considered. With the publication of this 2013 Thornberry study, there has been increasing interest in whether physiotherapy related exercises for the neck, scalp muscles and cervical spine could provide benefit to relieving some of the symptoms of the scalp dysesthesias. The optimal exercises remain to be determined although a series of simple exercises may help and are outlined in the videos below. We recommend that each patient review these exercises with their own physician or physical therapist before startint to ensure that they are done properly and that there are no particular reasons to avoid doing them in the first place.


VIDEO 1: SCALP AND NECK EXERCISES 1

A very nice video by Michelle Kenway. This is one of the favourite videos for our patients which provides an excellent means of addressing the neck and scalp.

VIDEO 2: SCALP AND NECK EXERCISES 2

A very informative video by physical therapists Bob Schrupp and Brad Heineck which provides tips for soem excellent exercises

VIDEO 3: SCALP AND NECK EXERCISES 3

An excellent video by chiropractor Dr Mandell. Tips are provided on how best to target the levator scapulae

VIDEO 4: SCALP AND NECK EXERCISES 4

A very informative video byCaroline Jordan which supplements the above exercises.

VIDEO 5: SCALP AND NECK EXERCISES 5

Another nice set of exercises by chiropractor Dr Mandell with towel exercises


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887



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