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Burning scalp syndrome: what is trichodynia?

19/9/2023

Translation: Elicia Payne

We all know what headaches are like – but scalp pain? Let me tell you what trichodynia is all about. And what you should definitely refrain from doing if you have pain at the hairline.

Sometimes, combing your hair becomes an impossible exercise and every touch of your scalp is torture. If you’re familiar with this pain, you probably have trichodynia, also called burning scalp syndrome.

Even though it sometimes feels like it, it’s not the hair itself that hurts, of course. After all, hair is a filament that grows in the epidermis and is made of keratin – which is an evolution of the reptile scales and was already present in a similar form in dinosaurs. At least that’s how Gerald Staguhn describes it in his book «Und ewig lockt das Haar»(The Endless Hair Spiral).

The dead hair itself isn’t painful. Trichodynia causes pain elsewhere: the entire head of hair is overstimulated. The hair root, hair bulb and hair follicle are inflamed and the surrounding scalp is particularly sensitive. «The hair leads a double life,» writes Staguhn. «It’s alive and dead at the same time».

There are many reasons for scalp pain – from improper care to parasite infestation. Speaking of which: you can identify whether its head lice causing the itching at a (close) glance. This means you should wash your hair with special anti-lice shampoo.

I spoke with Malte Schmelter, expert in dermatology at the Skinmed clinic, about the causes of trichodynia, what the classic symptoms are, how you can recognise serious scalp disorders, and how to treat the condition.

**It’s estimated that 1 in 5 suffer from burning scalp syndrome. Do you see this in your everyday working life?

**Malte Schmelter: **These are figures that come from large-scale Turkish studies, I can’t confirm that from everyday clinical practice. But trichodynia is also relatively common here. It’s certainly an underestimated disease, but it’s usually relatively short-lived.

What happens when you have trichodynia? What are the classic symptoms?

Trichodynia describes the paraesthesia of the scalp or hair. The classic causes are, for example, too frequent hair washing or too tightly tied braids that pull the hair and irritate the hair root system. Dyeing the hair often leads to skin irritation too. In addition, various allergies – for example to hair dyes – but also diseases of the scalp, neurodermatitis, psoriasis or fungal infections can be the trigger. The most common symptoms are a dry, irritated scalp and scalp pain.

** Low mental wellbeing has also been discussed as a possible cause. What is the relationship between trichodynia and stress?**

That’s a difficult question. Stress itself is rarely the trigger, but rather the mechanism for dealing with stress. Trichodynia occurs, for example, when people under stress scratch their scalp more often, pluck their hair or stroke their hair more often – which irritates the scalp. However, the scalp pain can also be caused by tension in the neck, which then moves upwards (also a symptom of stress).

What are the risks of untreated trichodynia?

Trichodynia is relatively harmless in most cases. If a severe infection is carried over, for example in the case of a fungal infection or a bacterial infection, in the worst case sepsis – blood poisoning – can occur. However, if it’s triggered by tension, stress or frequent hair washing, trichodynia isn’t necessarily dangerous. If the inflammations of the scalp cover large areas or there’s signs of scalp disease, you should consult a doctor.

How do I know if there’s a serious infection or scalp disease behind the trichodynia?

You can see for yourself whether it’s a more serious infection: is the scalp reddened? If so, then an inflammatory process is underway or there’s a pathogen infestation. In general, if the scalp is red and the scalp pain lasts longer than six weeks, you should consult a doctor.

Who is particularly affected by trichodynia? What risk factors are there?

Those particularly affected are people with systemic diseases of the scalp such as psoriasis or neurodermatitis. However, all cap wearers or people who wear helmets at work also have a higher risk of bacterial infections or fungal infections because they sweat more under their headgear. People who frequently dye their hair are also more likely to be affected. The scalp is often irritated or even allergic to the dye.

There are many causes of trichodynia. How do you proceed with the treatment?

It depends on the diagnosis. If inflammation is present, anti-inflammatory treatment is required, for example with cortisone. In case of allergic reaction, trichodynia should also be treated with anti-inflammatory drugs. If burning scalp syndrome is caused by a bacterial infection, there’s soaps and solutions, and in an emergency, antibiotics. However, if it’s simply dry scalp, there are great remedies with urea in combination with polidocanol, a local anaesthetic that relieves itching and moisturises the skin.

**What can I do at home for trichodynia? **

The first thing you can do is look at your own hair to see if your scalp is red or inflamed. If so, you should go to the doctor immediately. If it’s just itching, solutions with urea in combination with polidocanol can be applied to the scalp or used as a shampoo. Oils can also help soothe pain and itching on the scalp. Otherwise, the rule for trichodynia is to wash your hair less often, don’t tie your hair up when the pain is severe, and don’t blow dry your hair on the hottest setting. Additionally, you should avoid running your hands through your hair frequently. Instead, you can massage the targeted areas of the scalp very lightly. In this way, the scalp is better supplied with blood and important nutrients, which additionally alleviates the discomfort.

Header image: Shutterstock

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Olivia Leimpeters-Leth

Autorin von customize mediahouse

oliver.fischer@digitecgalaxus.ch

I'm a sucker for flowery turns of phrase and allegorical language. Clever metaphors are my Kryptonite – even if, sometimes, it's better to just get to the point. Everything I write is edited by my cat, which I reckon is more «pet humanisation» than metaphor. When I'm not at my desk, I enjoy going hiking, taking part in fireside jamming sessions, dragging my exhausted body out to do some sport and hitting the occasional party.

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