Scalp symptoms (burning, tingling, pain) and chronic telogen effluvium

Trichodynia in CTE: Common but Poorly Understood

"Trichodynia" literally means hair pain (both from the Greek roots  θρίξ ‎(thríx, “hair” and .οδύνη odúnē "pain). Trichodynia is poorly understood and too often incorrectly described.

Trichodynia is not a diagnosis. Rather it's a symptom that patients report of pain and burning. Initial studies by Rebora et al suggested that 34 % of those with hair loss have painful sensations in the scalp. In another study, Grimalt reported that 22 % of women with hair loss had trichodynia. This includes those diagnosed with chronic telogen effluvium but also those with androgenetic alopecia and other types of hair loss. Even those with depression and anxiety can experience scalp pain. Trichodynia is twice as common in women as in men. 

Taken together,  trichodynia is not specific for any one kind of hair loss.  However, it appears to be much more common in those with CTE. In fact, Rebora first proposed that trichodynia was specific for CTE. That however, does not appear to be quite accurate.  Trichodynia is seen in many conditions. Trichodynia is reported by some as synonymous with red scalp syndrome. This too is not true. These two conditions are different. While some patients with red scalp syndrome have trichodynia, most patients with trichodynia do not end up being diagnosed with red scalp syndrome. 

The cause of trichodynia is unknown but probably due to many different factors - all that lead to trichodynia. At a biochemical level, it appears that increased levels of a chemical called substance P in the scalp can contribute to trichodynia. 

Treatment of trichodynia is challenging. My approach is a mix of anti seborrheic shampoos, topical capsaicin shampoos, topical steroids and sometimes pharmacological agents such as gabapentin, amitriptyline, nortriptyline, SSRIs.