Trichodynia: causes, symptoms, treatments

By Cristiano Antonino On Apr 19, 2023

Let’s talk about trichodynia: any type of hair loss can be physically and mentally difficult to experience, however, there are some types of hair loss that are accompanied by other conditions or syndromes, such as trichodynia

In a study that assessed 249 patients for the presence of trichodynia, 35.7 per cent experienced the syndrome together with other hair loss conditions.

During the study, they also found that the condition was more common in females than males [1].

What is trichodynia?

Trichodynia is a syndrome that sometimes accompanies hair loss.

It causes a burning, stinging or itching sensation on the scalp, which can increase in pain or intensity when something comes into contact with the scalp.

Trichodynia is also known as burning scalp syndrome

It is also sometimes confused with scalp dysesthesia and skin dysesthesia syndrome.

These conditions are similar, but trichodynia can affect both hair and skin.

Scalp dysesthesia tends to be localised to the scalp skin [2].

This condition is sometimes related to psychological conditions, 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 hair loss caused by stress that occurs 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 suffering from diffuse alopecia [3].

A recent survey found that 14% of people suffering from diffuse alopecia also suffered from trichodynia [4].

Symptoms of trichodynia

The main symptom of trichodynia is a burning or itching sensation on the scalp and hair.

It is commonly caused by stress or recent 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 does not always present with redness, scaling or swelling. Therefore, a doctor must first rule out any skin condition [4]. Although conditions such as scarring alopecia, decalvating folliculitis, lupus and hair dye-related dermatitis can all present with burning and itching of the scalp, they are not directly associated with trichodynia.
It is common for trichodynia symptoms to be accompanied by hair loss or hair loss. The natural hair growth cycle can also be interrupted by factors such as stress, which affects hormones. For this reason, both telogen effluvium and diffuse thinning can be a catalyst.

Causes of trichodynia

Trichodynia is a syndrome, which means that the direct cause of it is unknown.

However, there are a number of factors that could contribute.

Trichodynia is more common in those with scarring alopecia than in other groups, as it is an inflammatory disease that causes pain and scarring [1, 5].

Here are some other potential causes or contributors.

Neurological disorders

The syndrome may be caused by a contortion in neuropeptide substance P, a neurotransmitter that modulates pain. This can reduce the pain threshold [6].

It is common to experience scalp dysesthesia with multiple sclerosis.

Although this condition is not the same as trichodynia, many of the symptoms are similar.

Multiple sclerosis breaks down the lining that protects the nerves, allowing pain receptors to increase their expression [7].

Psychiatric disorders

Trichodynia is evident in many of those who suffer from psychiatric conditions, such as depression and anxiety.

A study that included 91 people suffering from diffuse alopecia or telogen effluvium found that 30 of the subjects suffered from trichodynia.

The syndrome was found to be more prevalent in patients who suffered from depression [8].

One study focused on a woman who had suffered from depression for 6 years and was taking oral Trazodone.

She complained of burning and discomfort on her scalp and was found to suffer from trichodynia.

Propranolol reportedly reduced her symptoms [9].

Another study, which included 248 patients with androgenetic alopecia or telogen effluvium, found that 29% of subjects suffered from trichodynia.

In these patients, this condition co-existed with depression, obsessive compulsive disorder and anxiety [10].

Treatments for trichodynia

Depending on the cause of trichodynia, there are a few different options for treatment.

Treating the underlying condition, such as stress or emotional upset, can solve the problem.

However, there are some conditions that are not easy to treat, such as neurological conditions.

Talk to your doctor if you are concerned.

Since trichodynia is a syndrome, there is no proven way to treat it.

However, there are several treatments available to try.

Stress and anxiety management

If stress is the problem, there are a few ways to combat it, from mindfulness to medication.

You should discuss the best way forward with a doctor, but some people find that bringing to light the stressors that cause the condition helps.

You could do this through therapy, meditation or by making a change in your life.

People suffering from these conditions may also find yoga helpful, as it provides the body with healthy movement while relaxing the mind [12].

Ensuring that you get plenty of sleep, nutrition and sunlight is also an essential part of stress management.

Medication

Although there is no specific medication for trichodynia, you may be able to use a pharmaceutical treatment to treat the symptoms.

This condition is characterised by inflammation, so some patients may be prescribed an anti-inflammatory drug, while others may be prescribed a steroid hair loss cream, a drug containing L-cystine or topical corticosteroids [13].

Some studies suggest that the use of antidepressants or anti-anxiety drugs, such as propanolol and amitriptyline, are effective for the treatment of underlying psychological conditions [9, 13].

Medications such as Finasteride and Minoxidil can be prescribed in cases of hair loss and trichodynia.

Is trichodynia permanent?

Trichodynia is not always permanent. If it is caused by a treatable underlying condition, it may recede when the trigger is removed.

With some recurring or permanent conditions, trichodynia may last longer, but can be managed with medication or treatment.

In most cases, any hair loss should regrow once the underlying condition is treated.

Some conditions cause scarring with hair loss.

In these cases, hair loss may be permanent.

Does trichodynia lead to hair loss?

Trichodynia per se does not usually cause active hair loss.

However, it may be accompanied by other conditions causing hair loss, such as telogen effluvium, scarring 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 were not directly related [14].

This suggests that trichodynia does not directly cause hair loss, but may occur together with it.

Trichodynia and telogen effluvium

Telogen effluvium is a type of hair loss, usually caused by shock, stress or trauma; it appears as hair loss such as thinning or loss of large or irregular 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.

This means that both conditions may appear together [15].

In a study of 128 people, trichodynia was present together with telogen effluvium in 42.4 % of the subjects [11].

When the conditions occur together, hair loss or thinning is likely to start along with symptoms of burning, itching and crawling.

Does anxiety cause trichodynia?

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 in those with telogen effluvium and alopecia areata without trichodynia [16].