Trichodynia: Burning Scalp Syndrome

More often than not, people who are experiencing hair loss are unaware of the reason behind it. Sometimes it’s just hair shedding, which is worrying enough on its own.

However, at other times, hair loss is accompanied by some other worrying symptoms, which could indicate the presence of an underlying health condition. Trichodynia is one such problem.

Trichodynia/burning scalp syndrome is a “syndrome”, which means that a direct, defining cause for the condition is not known or established.

However, it gives rise to a number of symptoms that may be symptomatic of another health condition. Let’s find out more about the causes, symptoms, and treatments of trichodynia.

What Is Trichodynia?

Trichodynia is a painful, burning sensation in the skin of the scalp or the scalp hair itself.

It may be that when you touch your scalp or hair, the intensity of the pain increases. The condition is also referred to as cutaneous dysesthesia syndrome or scalp dysesthesia.

Dysesthesia itself occurs as a result of damage to the peripheral nerves and is a response triggered by the central nervous system. It commonly occurs in multiple sclerosis.

The term “trichodynia” was first introduced almost 25 years ago. Its first case report came in as far back as 1696, along with alopecia areata universalis (hair loss all over the body).

However, it was in 1960 that a paper reported that women experiencing telogen effluvium also had symptoms of trichodynia. The patients experienced the following:

  • itching 
  • burning 
  • tingling
  • tenderness
  • crawling sensations
  • discomfort

People with burning scalp syndrome won’t have any flakiness or rashes on the skin of their scalp.

One study conducted on patients admitted to a hospital at Istanbul University showed that trichodynia was more common in women than men.

Out of the 249 people who took the questionnaire, 89 had burning scalp syndrome. Patients with cicatricial or scarring alopecia also showed symptoms of burning scalp syndrome.

What Are the Scalp Symptoms of Trichodynia?

The symptoms of what was then termed a “new syndrome” were reported in a paper published in the Archives of Dermatology in 1998.

Interestingly, according to the study, the patients who had “burning, itching and stinging” sensations accompanying trichodynia were also going through some psychological or physical stress.

Of the 11 women who participated in the study, 5 reported experiencing pain, stinging, and burning; 4 had pain and pruritus (itchiness due to scalp dryness that can occur due to skin diseases, psychiatric disorders, internal diseases, or allergy); 2 women only had pruritus.

Many women had mental health conditions, and they reported that trichodynia worsened when they were under stress. 9 out of 11 women found the intake of antidepressants helpful in treating the symptoms of this syndrome.

What Are the Causes of Scalp Dysesthesia?

The painful sensation in scalp dysesthesia in the skin of the scalp and/or hair follicles may result from the release of substance P, a neurotransmitter (released by neurons on stimulation) and modulator of pain perception.

It plays a role in the promotion of inflammation in the body in various ways. It is this elevated expression of substance P that makes the person more aware of the sensation of pain i.e., pain sensitivity increases. Its release has been found to increase in the case of inflammatory diseases.

The pain trichodynia patients feel, according to the paper published in 1960 by Sulzberger et al., mentioned above, may occur in certain areas of the scalp.

It should be noted that substance P release can cause reticulated or diffuse erythema, which results in the formation of large red patches on the skin due to the dilation of blood vessels. People with trichodynia may also have diffuse erythema due to the release of substance P.

Psychiatric Disorder & Scalp Dysesthesia

The increase in expression of the substance P is also linked with psychiatric disorders. This substance P may be responsible for the symptoms of trichodynia in the skin of the head and hair follicles.

Many studies have shown that patients with telogen effluvium and diffuse alopecia experience trichodynia. A paper published in Clinical and Experimental Dermatology in 2009 showed that trichodynia was more common in patients who had diffuse alopecia, depression, and somatoform dissociation disorders.

In another study published in the International Journal of Dermatology with 248 participants, 153 females and 95 males, an association occurred between trichodynia and androgenetic alopecia and telogen effluvium.

Moreover, the researchers found that cutaneous dysesthesia syndrome is more common in patients who have psychiatric disorders, such as obsessive-compulsive disorder (OCD), anxiety, and depression.

Unrelatedly, a study comprising 15 women with scalp dysesthesia found that 14 of them also had abnormal cervical spine (the topmost/first region of the vertebral column).

COVID-19 & Trichodynia

A paper published in JAAD International tried to find out whether there was a relationship between trichodynia, telogen effluvium, and COVID-19. For this purpose, 128 patients with COVID-19 were made a part of the study. It showed that 58.4% of patients had trichodynia while 66.3% had telogen effluvium.

The symptoms of this type of hair loss started in the first month of diagnosis for some patients, while for others, they appeared after 3 months or more. The more severe the symptoms of COVID-19, the more severe the hair loss due to telogen effluvium.

Nutritional Deficiency

Some suggest that there may be a relationship between nutritional deficiencies and the release of substance P.

Although according to one study published in the International Journal of Trichology, there is no relationship between trichodynia and the levels of “vitamin B12, thyroid-stimulating hormone, zinc, ferritin, and folate” in the body.

Does Trichodynia Result in Hair Loss?

The burning, painful sensation that occurs in scalp dysesthesia can be quite stressful, especially if you don’t know why it’s happening. And that too can cause stress hair loss.

Moreover, the itchiness accompanying it can make the person want to scratch their scalp quite often. This can weaken the hair roots and cause them to enter the telogen phase.

In a case study, a 76-year-old woman complained of pain in her scalp whenever she touched it, combed it, or wore a hat. She also reported hair loss and a burning sensation. She had been taking an antidepressant for 6 years.

On examination, the scalp had no lesions. However, the patient had dilated blood vessels and mild hair thinning. Therefore, hair loss occurs as a result of burning scalp syndrome.

Is The Hair Loss Permanent?

It isn’t known if trichodynia on its own can result in permanent hair loss. However, commonly patients with trichodynia have androgenetic alopecia or pattern baldness which results in permanent hair loss.

Trichodynia is also found in patients with alopecia areata, which in rare cases, can result in permanent damage to the hair follicles.

Many people with this condition also have telogen effluvium. However, that kind of hair loss is reversible.

What Is The Treatment For Trichodynia?

Depending on the potential cause of trichodynia, there are some treatment options for it.

Stress Management

One reason why scalp dysesthesia may occur is stress. For that, the patient can try managing their stress levels through different techniques. This is one treatment for trichodynia.

Ample sunlight, a healthy diet, a proper sleep schedule, and taking adequate rest every day is important. You can also consider meditation and yoga to better manage your stress levels. Also, make sure to eat healthily and try some gentle, relaxing massages.

Other than that, exercise regularly; seek professional therapy or counselling to make sure that you’re living your best life.


Since trichodynia is a skin condition, many wonder whether topical treatment would help. However, this doesn’t work in the case of scalp dysesthesia.

In the case study mentioned above, the researchers suggest that, for some patients, the beta-blocker propranolol can work to treat burning scalp syndrome. However, what works for someone else might not necessarily work out for you.

Whatever the explanation is for burning scalp syndrome, it is only a hypothesis at the moment. There’s no definitive cause for it. You may have to try out different trichodynia treatments before finding the one that works for you.

Steroids, anti-inflammatory drugs, antidepressants, and drugs containing L-cystine may work as a trichodynia treatment.

Use Gentle Hair Care Products

To be on the safe side, you should also make sure that you don’t use any harsh treatments on your scalp. Use shampoos and conditioners with mild formulas and avoid taking baths in hot water.

Key Takeaways

There are still many people who are unaware of cutaneous dysesthesia. It may occur as a result of psychiatric conditions or underlying health problems.

The hypothesis is that the release of substance P may have something to do with the increased pain sensitivity that occurs in scalp dysesthesia.

Symptoms include a sensitive scalp, burning, itching, pain, and stinging sensation, along with hair loss.

It is important to know that the same treatment might not work for different people. There may be some trial and error before you find the treatment that works out for you.

Exercise, a healthy diet, and stress management techniques can help relieve the symptoms of this syndrome. You can also consult your doctor about taking medications for it.

This condition is more common among patients with androgenetic alopecia, diffuse alopecia, and telogen effluvium. Some of these types of alopecia cause permanent hair loss, for which a hair transplant is the only permanent solution.

If you’re looking for a hair loss treatment, make sure to consult a trichologist or dermatologist for the most suitable treatment option. 

Reviewed and Approved by Trichologist Yaprak Yazan

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