Any type of hair loss can be physically and mentally challenging to experience, however, there are some types of hair loss that are accompanied by other conditions or syndromes, such as trichodynia, a painful sensation on the scalp.
In a study that assessed 249 patients for the presence of trichodynia, 35.7% were found to have been experiencing the syndrome alongside other hair loss conditions. During the study, they also found that the condition was more common in females than males [1].
Trichodynia is a syndrome that sometimes accompanies hair loss. It causes a burning, crawling, or itching sensation on the scalp, which may increase in pain or intensity when anything comes into contact with the scalp.
Trichodynia is also known as burning scalp syndrome. It’s also sometimes confused with scalp dysesthesia and cutaneous dysesthesia syndrome. These conditions are similar, but trichodynia can affect the hair as well as the skin. Scalp dysesthesia tends to be localised on the scalp skin [2].
This condition is sometimes linked to underlying psychiatric disorders, such as anxiety and depression, or neurological disorders. It can also occur due to peripheral nerve damage in conditions such as multiple sclerosis.
Telogen effluvium has been linked to trichodynia. Telogen effluvium is a type of stress-based hair loss that happens when the hair growth cycle is interrupted, usually due to shock or trauma. This is how the syndrome was actually discovered.
In 1960, Sulzberger reported the symptoms of trichodynia in a study of women who were experiencing diffuse alopecia [3]. A recent survey found that 14% of people experiencing diffuse alopecia were also suffering from trichodynia [4].
The main symptom of trichodynia is a burning or itching sensation on the scalp and hair. It is commonly brought on by recent stress or trauma.
Another symptom is the formation of large, red patches on the scalp. These are caused by the dilation of blood vessels, also known as diffuse erythema, which occurs due to inflammatory factors:
Trichodynia doesn’t always present with redness, flakiness, or swelling. So a doctor must rule out any skin conditions first [4]. Although conditions such as scarring alopecia, folliculitis decalvans, lupus, and dermatitis related to hair dye can all present with burning and itching of the scalp, they are not directly associated with trichodynia.
It’s common for trichodynia symptoms to be accompanied by hair loss or hair shedding. The natural hair growth cycle can also be interrupted by factors such as stress, which affects the hormones. Because of this, both telogen effluvium and diffuse thinning can be a catalyst.
Trichodynia is a syndrome, which means that the direct cause of it is not known. However, there are a number of factors that could contribute.
Trichodynia is more common in those with scarring alopecia compared to other groups, as this is an inflammatory disease causing pain and scarring [1, 5].
Here are some other potential causes or contributors.
The syndrome may be brought on by a contortion in the neuropeptide substance P, a neurotransmitter that modulates pain. This may decrease your pain threshold [6].
It is common to experience scalp dysesthesia with multiple sclerosis. While this condition isn’t the same as trichodynia, many of the symptoms are similar. Multiple sclerosis breaks down the covering which protects the nerves, allowing pain receptors to increase in expression [7].
Trichodynia is evident in many of those who experience psychiatric conditions, such as depression and anxiety. A study comprising 91 people experiencing either diffuse alopecia or telogen effluvium, found that 30 of the subjects were suffering from trichodynia. The syndrome was found to be more prevalent in patients who were experiencing depression [8].
One study focused on a woman who had been suffering from depression for 6 years and was taking oral Trazodone. She complained of burning and discomfort in the scalp and was found to be suffering from trichodynia. Propranolol reportedly reduced her symptoms [9].
Covid-19 and hair loss have been linked in recent months. Within this, some cases have recorded trichodynia in Covid-19 patients due to telogen effluvium.
One study, consisting of 128 subjects who had suffered from Covid-19, reported that telogen effluvium was present in 66.3% of patients, while trichodynia was present in 58.4%. Trichodynia was associated with telogen effluvium in 42.4% of these cases [11].
62.5% of the subjects in the study began to develop trichodynia symptoms within the first month after a Covid-19 diagnosis, while 47.8% had symptoms that began after 12 or more weeks [11].
Depending on the cause of trichodynia, there are a few different options for treatment. Treating the underlying condition, such as stress or emotional upset, may resolve the problem. However, there are some conditions that aren’t easy to treat, such as neurological conditions. Speak to your doctor if you’re concerned.
As trichodynia is a syndrome, there is no one proven way to treat it. However, there are several treatments available to try.
If the problem is stress, there are a few ways to combat this, from mindfulness to medication.
You should discuss the best way forward with a doctor, but some people find that unearthing the stress factors causing the condition helps. You could do this through therapy, meditation, or making a change in your life.
People suffering from these conditions may also find yoga helpful, as this provides the body with healthy movement, whilst relaxing the mind [12].
Ensuring that you get plenty of sleep, nutrition, and sunlight is also an essential part of stress management.
While there’s no specific medication for trichodynia, you may be able to use pharmaceutical treatment to treat the symptoms.
This condition is characterised by inflammation, so some patients may be prescribed anti-inflammatory drugs, while others may be prescribed a steroid cream for hair loss, an L-Cystine containing medication, or topical corticosteroids [13].
Some studies suggest that the use of antidepressants or anti-anxiety medication, such as propanolol and amitriptyline, are effective for treating underlying psychological conditions [9, 13].
Medications such as Finasteride and Minoxidil may be prescribed if you have hair loss and trichodynia.
Trichodynia is not always permanent. If it’s caused by a treatable underlying condition, it may reverse when the trigger is removed. With some conditions that are recurring or permanent, trichodynia may last longer, but can be managed with medications or treatment.
In most cases, any hair loss should grow back once the underlying condition has been treated. Some conditions cause scarring with hair loss. In these cases, hair loss may be permanent.
Trichodynia itself does not usually cause active hair loss. However, it may be accompanied by other conditions which cause hair loss, such as telogen effluvium, cicatricial alopecia, and other forms of scarring alopecia.
According to a study that examined 403 patients, 29% reported hair pain, which was diagnosed as trichodynia. This study found that trichodynia and hair loss did not directly correlate [14]. This suggests trichodynia does not directly cause hair loss, but it may occur alongside it.
Telogen effluvium is a type of hair loss, usually caused by shock, stress, or trauma. It appears as hair loss such as thinning or losing large, or uneven patches. Unlike male pattern baldness and female pattern baldness, this type of hair loss is usually temporary.
Like trichodynia, telogen effluvium can be caused by stress, anxiety, or emotional upset. That means both conditions may appear together [15].
In a study of 128 people, trichodynia was present alongside telogen effluvium in 42.4% of the subjects [11]. When the conditions present together, hair loss or thinning is likely to begin along with the symptoms of burning, itching, and crawling sensations.
Anxiety does not directly cause trichodynia. However, studies have shown that the two are related.
One study found that anxiety was significantly higher in those patients who had telogen effluvium or alopecia areata with trichodynia than those with telogen effluvium and alopecia areata without trichodynia [16].
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