Burning scalp syndrome was not recognized as a separate entity by dermatologists until recently, and the symptom was considered part of nervousness or depressive illnesses. When there are identifiable skin and hair changes on the scalp, the diagnosis and treatment of burning scalp syndrome is straightforward. But if the patient complains of intractable burning sensations in the absence of skin or hair changes, this calls for detailed investigations.
Causes of Burning Scalp Syndrome
There are many hypotheses as to how the burning sensation is produced on the scalp and why it is very intractable to conventional therapies.
Normally, the hair has three stages in its life cycle: the growth phase or anagen, the resting phase or telogen and the falling stage or catagen. There is some evidence that the changes occurring within the hair follicle when it enters the resting or telogen phase produces a burning or warm sensation in the scalp. This is thought to be due to a chemical mediator known as substance P or neuropeptide P, which is responsible for pain and burning sensations within the skin in many skin diseases.
It is also noticed that following inflammatory reactions affecting the hair follicle, the hair goes into a telogen phase as a protective mechanism, with resultant increase of substance P within the hair follicle. This results in the burning and painful sensations as inflammation and hair loss progress.
- The burning sensation could also be due to irritation to the sensory nerve endings within the skin caused by stasis of blood circulation in the scalp due to inflammatory events on the scalp.
- Stasis of lymphatic drainage in the scalp due to any cause can also cause nerve irritation secondary to the accumulation of toxic excretory materials.
- In cicatricial alopecia where there is hair loss accompanied by hair loss on the scalp, there is accumulation of inflammatory cells and fibrous tissue in the dermis, leading to compression and irritation of the nerve cells. Cicatricial alopecia may be caused by Lichen planus (lichen planopilaris), lupus erythematosus and infections like folliculitis decalvans, dissecting cellulitis of scalp etc, hence burning scalp syndrome is a common symptom in these diseases.
- Some women have reported burning scalp sensations while on birth control pills, which was relieved after discontinuing the pills.
- Some patients with severe scalp psoriasis and pustular psoriasis have an itchy, burning scalp.
- Patients with allergic or irritant contact dermatitis to hair dyes may present with burning scalp with dermatitis changes on the scalp and surrounding skin.
- Finally, if no cause could be found, anxiety or depressive illnesses may be considered as a cause for the burning scalp syndrome.
The hair loss in burning scalp syndrome is generalized in majority of cases, though it can be localized to the area of inflammation in the cicatricial alopecias.
How to Get Rid of Burning Scalp Syndrome?
Burning scalp syndrome is quite resistant to treatment and is comparable to the notorious post herpetic neuralgia in causing distress in the affected. Finding and treating or eliminating the cause of the itchy burning scalp is the first step in the treatment of the burning scalp syndrome.
- Avoid irritating the scalp: Do not use hot or very cold water and harsh shampoos. Avoid scratching, pressure combing, very tight hair bands etc.
- Capsaicin cream relieves the burning sensation through a counter irritation mechanism. It can be applied 3-4 times daily to the scalp. Capsaicin acts by blocking the P factor in the hair follicles. It is started in a dose of 0.025% 4 times daily and increased up to 0.075% concentration if necessary.
- Scalpicin solution applied twice daily relieves the burning sensation in most patients, though after a few days, the effectiveness is seen to reduce. Alternating with capsaicin cream gives better results.
- Moisturizing shampoos like Dove or Sebamed should prevent excessive drying of the scalp. Margo Alive shampoo which contains capsaicin is useful in patients with burning scalp syndrome.
- Soft massages and scalp exercises may help some patients.
- Antidepressant medications like doxepine or amitryptaline helps in relieving the burning sensation by reducing the substance P and also through their actions on the central nervous system. It may take 2-4 weeks for the medications to take positive effect.
- Patients with lichen planopilaris and other inflammatory diseases will get relief from phototherapy with Psoralen-UVA or narrow band UVB therapy. Special UV combs are commercially available for this purpose.
- Adjunctive measures like biofeedback, relaxation techniques and hypnotherapies may help in resistant cases.
Burning scalp syndrome, though a distressing disease, can be kept at bay with proper diagnosis and management with appropriate medications.
The readers of this article may find the following articles useful:
Reference
- Various Text Books and Journals in Dermatology
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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