Topical steroids for Pain from Telogen Effluvium

Topical steroids for telogen effluvium related pain

 
I’ve selected this question below for this week’s question of the week. It allows us to review some concepts in treating scalp pain in the setting of telogen effluvium.

Question

What is the best topical steroid for TE pain?

Answer

This is a great question and really requires me to see the scalp up close and know more about the story. I would want to make sure first of all that the pain is truly coming the TE and not something else. There are many many conditions that mimic TE that give scalp pain. However those are not TE and a completely different approach is going to me needed.

Some common examples of conditions that look like TE but are not TE and give pain are: lichen planopilaris, psoriasis, seborrheic dermatitis, dermatomyositis, allergic contact dermatitis,

So what is the best steroids for TE related pain in general?
Well probably none unless clearly there are inflammatory issues going on too. Corticosteroids don’t do much for this in most cases. A steroid like betamethasone valerate 0.1 % is safe to try for a few days of course (under supervision from a physician). But if it takes away pain, I’d be wondering actually if there is an underlying issue like seborrheic dermatitis that is actually being treated.

If a patient gets lots of relief from steroids and they think they have TE, a careful exam should be done to confirm if another diagnosis is present (or biopsy).

No, steroids are not really a solid option for TE pain.

The best treatment is to treat the cause of the TE.

Pain and tenderness and ‘trichodynia’ can absolutely be a part of telogen effluvium symptoms. The issue however is that we typically don’t use steroids all that often. they can be tried of course if other causes have confidently been ruled out.

Other options include low dose naltrexone, topical gabapentin, topical TKAL, oral gabapentin, Lyrica, hypoallergenic shampoos, apple cider vinegar.

All in all, if a lot of relief comes from topical steroids, I would be asking myself “Are we missing another diagnosis?”