IF YOUR SCALP ITCHES, BURNS AND STINGS FOR NO APPARENT REASON, WHETHER YOU HAVE HAIR LOSS OR NOT, YOU MAY HAVE BURNING SCALP SYNDROME.
Some of the most difficult disorders to treat are those that a medical provider can’t prove or see, especially for a dermatologist treating obvious disorders of the skin and scalp. Eric Schweiger, M.D., associate at Bernstein Medical — Center for Hair Restoration and New York City board-certified dermatologist and hair transplant surgeon, explains, “‘Burning scalp syndrome’ is the layman’s term for the scalp disorder characterized by chronic skin symptoms without objective clinical findings that we call scalp dysesthesia.” He explains that without the physical findings to support a cause for the itching, burning and stinging, it is classified as a somatoform disorder, so there is a presumed psychological cause. “The exact cause is unknown; it is exacerbated by psychological or physical stress. There may be an underlying psychological disorder or chronic pain syndrome, and it is unclear why some people feel that painful burning sensation. There is generally not a physical sign or dermatological condition associated with the initial pain,” says Dr. Schweiger.
“In some cases, burning scalp syndrome can be long-lasting, says Schweiger. We don’t know why some patients with burning scalp syndrome improve, while others require long-term treatment. We see the condition more common in women, and one study published in Dermatology in 2002 showed that it is almost twice as common in women as in men because of gender differences in pain perception in relation to anxiety.”
Some hair loss conditions cause burning and pain in the scalp
According to a study published in Dermatology in 1996, the authors found that 34 percent of patients with some type of hair loss, including simple male or female pattern and age-related hair loss, suffer painful sensations in the scalp with no pathological physical finding, other than the hair loss. It’s also widely documented that early androgenetic alopecia can be associated with a slight tingling or slight tenderness of the scalp. Patients undergoing total hair loss due to chemotherapy also report an especially painful and sensitive scalp during the initial stages of the hair loss.
Central centrifugal cicatricial alopecia (CCCA) can be the culprit if patients have recently had a chemical or color process done that mildly irritated their scalp to the point of burning, itching and stinging with or without hair loss. CCCA most often resolves on its own if there is no scarring or permanent damage to hair follicles or the scalp. In the case of trichodynia, hair pain can be an early manifestation of traction alopecia, caused by a tight hairstyle pulling on hair follicles to the point of pain but before there are other physical signs of traction alopecia, such as hair loss, pimples and inflammation around the hairline.
Telogen effluvium, a sudden hair shedding, caused by physical or emotional trauma also can cause some scalp discomfort, which usually resolves itself after several months, says Schweiger. “Generally speaking, there is no physical manifestation, including no hair loss, involved with burning scalp syndrome.”
Treatment for burning scalp syndrome
According to Clinical Management in Psychodermatology, treating burning scalp syndrome is tricky because while patients with a clear skin disorder are given a physical treatment that results in improvement of the condition, somatoform patients may feel isolated by the assurance that they are healthy and do not have to worry. Schweiger adds, “Traditional dermatological treatments for itching and burning do not help significantly. The most effective treatment appears to be an appropriate prescription for low-dose antidepressants.”
In addition, Clinical Management in Psychodermatology recommends maintaining a pain diary, which might help to establish stressors that can be discussed with your doctor at the next appointment. Getting educated about the syndrome and learning different relaxation techniques are parts of the prescription for treatment.
If you think you have burning scalp syndrome, definitely have a dermatologist examine your scalp and advise or refer you further, says Schweiger.