Treatments for Scalp Dysesthesias
Question:
I have been to over 7 dermatologists and several other doctors as well. I have been told I have a diagnosis of ‘scalp dysesthesia.’ For almost two years, I have had severe scalp burning and hair loss. My doctors put me on several benzodiazepines but it makes my shedding worse. I have had no luck.
Do you have any suggestions?
Answer
Thank you for your question. The scalp dysesthesias are a group of conditions that are associated with marked scalp symptoms in the absence of any underlying obvious disease of the scalp. When hair loss is present together with the scalp symptoms one must strongly consider the possibility that the scalp symptoms could be due to the hair loss condition as well or perhaps even solely from the hair condition.
There are many causes of scalp dysesthesias rather than a single cause. Cervical spine disease, neurological disease, depression are some of possible the underlying causes. It seems that patients worsen with stress. When hair loss is present one must always consider whether a primary scalp issue is the reason for the symptoms. A full review of a patient’s medical history as careful examination of the scalp is necessary to rule out primary causes such as scarring alopecia, psoriasis, seborrheic dermatitis, telogen effluvium. Blood tests for vitamin, mineral and hormonal abnormalities are needed and if any doubt exists a biopsy may be needed as well. Patch testing may be needed if allergic contact dermatitis is considered.
There are many possible treatments for scalp dysesthesias including antidepressants (SSRI, tricyclic antidepressants), oral gabapentin, and oral prebagalin (Lyrica). Topical agents such as topical gabapentin or topical TKAL (ketamine, amitriptyline, lidocaine) can be considered as well.
There are a variety of non-pharmacological techniques that can be used to combat the scalp symptoms that patient’s with scalp dysesthesias experience as well. These include:
1. Ice packs or Cool water
Ice packs, frozen peas and cool towels are useful for many individuals with challenging scalp syndromes. These are safe to use provided they are not too cold and not left on too long.
2. Apple cider vinegar
Apple cider vinegar rinses are helpful for individuals with many different scalp syndromes including itching, burning and pain. Most often the apple cider vinegar is diluted 1:4 in water and applied to the scalp for 5-10 minutes before rinsing off.
3. Witch hazel
Several herbal ingredients are proposed to have an anti-irritant tendency and can be helpful in scalp pain syndromes. These include chamomile (Marticaria chamomilla), heart seed (Cardiospermum halicacabum), peony (Paeonia lactiflora), and the virginian witch hazel (Hamamelis virginiana). Witch hazel in particular has received great attention. We generally recommend application of pure witch hazel with a cotton ball for periods of 5-10 minutes before rinsing off. Many patients find relief from these agents.
4. Allergen free shampoos
Although contact allergy must be considered in patients with scalp symptoms, a variety of allergen free shampoos can be considered even in the absence of any evidence of a true scalp allergy. A list of helpful low allergen shampoos is provided in the link below
5. Vitamin C
Vitamin C or ascorbic acid occasionally helps some individuals with scalp nerve and pain syndromes. The dose is 500 mg daily.
6. Low level laser therapy.
Low level laser therapy (LLLT) involves the application of red light therapy to the scalp. The treatments were originally designed for use in androgneetic alopecia but have helped many patients with scalp dysesthesia. Some patients, however, find that the warmth of these devices makes their scalps feel worse. Therefore LLLT is not helpful for everyone.
7. Menthol
Products with menthol have a cooling effect and help some patients. Many of our paitents have found relief from a tea tree oil menthol – peppermint product from Holista products. These are available on amazon as well. Ingredients include denatured alcohol, water, glycerin, Melaleuca alternifolia (Tea Tree) leaf oil, menthol, Mentha piperita (Peppermint) oil. We recommend 3-4 sprays up to three times daily
8. Relaxation, medication, yoga and tai chi
Many of our patients have experienced tremendous benefit from the practice of a variety of techniques.
Conclusion and Summary
I would need to examine your scalp and obtain a great deal more information to determine how best to proceed. The fact that you have hair loss makes it important to make sure there is not one or more hair conditions present as well. As mentioned above, many hair and scalp disorders are associated with scalp symptoms. If this is the case, it may or may not be appropriate to actually use the term scalp dysesthesia.
Blood tests are essential in anyone with scalp symptoms. Typical tests to consider include CBC, TSH, ferritin, zinc, ANA, ESR. Other blood tests may be important as well depending on the precise story. In your case, as well as with all patients with scalp dysesthesia, a scalp biopsy and consideration of patch testing needs to be discussed. These are certainly not appropriate for everyone but they must be considered. Evaluation for potential cervical spine disease (with x-ray +/- magnetic resonance imaging) and a detailed specialist evaluation for potential neurological, rheumatological