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Scalp Dysesthesia

Overview

Scalp dysesthesia is a condition that results in an abnormal burning, prickling, or tingling sensation on the scalp. It can be caused by a variety of factors, including head/neck/back injury, degenerative joint disease and arthritis in the neck, infection, nerve damage, and exposure to certain chemicals. It is more common in middle aged to elderly women and many patients tend to have a history of anxiety/depression. Symptoms may vary from person to person, but can include feelings of intense heat or coldness, pain, itching, or tingling. Diagnosis is typically made based on symptoms alone; however, additional tests including biopsy may be ordered to rule out other causes. Some patients report feelings of formication or “bugs on the skin”. Workup can include imaging tests. Treatment options vary depending on the underlying cause of scalp dysesthesia but often focuses on making the sensation more tolerable rather than curative therapies. Treatment is sometimes coordinated with psychiatry and neurology. Prognosis is variable. Some patients report lifelong symptoms while others may only have them for a short period of time. Scalp dysesthesia can be a difficult condition to manage and often requires a multidisciplinary approach.

What causes scalp dysesthesia?

Scalp dysesthesia is thought to represent an abnormal nerve sensation. It can be caused by a variety of factors, including head/neck/back injury (for example after a motor vehicle accident) or more chronic degenerative joint disease and arthritis in the neck. Occasionally scalp infections (tinea capitis, seborrheic dermatitis) can result in abnormal sensitivities even after treatment. Other causes of nerve damage including neurotoxic chemicals could also contribute. It is more common in middle aged to elderly women and many patients tend to have a history of anxiety/depression. There is no known genetic link.

What are the symptoms of scalp dysesthesia?

The primary symptom of scalp dysesthesia is pain, burning, or itchiness on the scalp. This may be a constant feeling or may come and go. Other symptoms may include tingling, numbness, or sensitivity to touch. Some patients may report the feelings of bugs, parasites, or other insects crawling on their skin.

How is scalp dysesthesia diagnosed?

Scalp dysesthesia is diagnosed based on a person’s symptoms. A physical examination may be performed to rule out other causes of scalp itchiness such as seborrheic dermatitis, psoriasis, or tinea capitis. Typically patients with primary scalp dysesthesia have no significant scaling or redness but may demonstrate signs of excoriation (scratching). A biopsy is sometimes offered to patients to exclude other causes.

How is scalp dysesthesia treated?

Treatment of scalp dysesthesia is challenging and often requires a multidisciplinary approach. If there is a primary cause of the scalp dysesthesia such as an acute spine injury or chronic degenerative changes, surgery or physical therapy may be helpful. Topical medications such as Sarna anti-itch lotion with menthol and camphor may distract some itching. Topical lidocaine, gabapentin, and amitriptyline may help reduce sensations with minimal side effects. Sometimes systemic therapy with gabapentin or amitriptyline may be needed. Antipsychotic medications such as pimozide or olanzapine may be effective (not necessarily for antipsychotic properties) but to reduce sensitivity to nerve impulses. The label of antipsychotic can limit buy-in with these types of therapies. Cognitive behavioral therapy to learn how to deal with the sensations can be helpful.

What is the prognosis of scalp dysesthesia?

In causes with a clear primary cause (such as an acute spine injury or chronic degenerative changes) prognosis can be good after surgery or physical therapy. In the absence of a clear cause treatment focuses on improving tolerability of symptoms and prognosis is variable. Many people still struggle with managing symptoms over time.

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