Diagnostic and therapeutic approach to scalp dysesthesia: A case series and published work review

Abstract

Scalp dysesthesia may be underrecognized but is an important condition which requires special management strategies. Through our case series of four patients, we have noted that patients were frequently misdiagnosed with seborrheic dermatitis and failed standard treatment. However, patients did benefit from low doses of oral pregabalin and a topical compound of amitriptyline, lidocaine and ketamine. Oral antihistamines and topical corticosteroids did not work sufficiently on their own but added value when used in conjunction with analgesic agents. Our experience and published work also suggest the association of cervical spinal changes, psychiatric disorders, and other environmental and habitual factors.

Scalp dysesthesia. Case report

“…As the SD is a syndrome associated with changes of the fine fibers, it is treated as a neuropathy, using gabapentin associated with a low dose of tricyclic antidepressants, in this case, amitriptyline, achieving satisfactory results. Most cases already reported in the literature, as well as the present one, showed good response and even complete absence of reported clinical symptoms [1][2][3][4] . Among other forms of treatment, there is the association of drugs, not yet available in Brazil, made of amitriptyline, ketamine and lidocaine 4 , in addition to physical exercise and physiotherapy, since the SD can be directly related to cervical and spine problems 8 .…”

“…Most cases already reported in the literature, as well as the present one, showed good response and even complete absence of reported clinical symptoms [1][2][3][4] . Among other forms of treatment, there is the association of drugs, not yet available in Brazil, made of amitriptyline, ketamine and lidocaine 4 , in addition to physical exercise and physiotherapy, since the SD can be directly related to cervical and spine problems 8 . This syndrome is characterized as a challenging and frustrating condition for the patient and the physician, as it has no pathogenesis or well-established or even evidence-based treatments.…”

“…It has no preference for race or gender, nor is it considered a serious disease, but it has several negative impacts on the patient's quality of life 6 . It is clinically characterized by the presence of several localized or diffuse symptoms, such as burning, pain, pruritus, or stinging sensations, and more than one dysesthetic sensation may be present in the same area 4 . In order to make the diagnosis, which is essentially clinical, the absence of a primary cutaneous disorder is necessary, and in the literature some dermatoscopic patterns are proposed in patients with this syndrome.…”

“…It is characterized by the presence of several localized or diffuse symptoms, such as burning, pain, pruritus or stinging sensations, in the absence of a primary cutaneous disorder 2,3 . It is often underdiagnosed and mistaken for seborrheic dermatitis 4 . It can be caused by a psychiatric condition, nerve injury, muscle tension, or direct surgical injury.…”

Use of H-1 Antihistamine in Dermatology: More than Itch and Urticaria Control: A Systematic Review

“…Oral pregabalin, gabapentin, and topical analgesic agents were considered first-line medications for scalp dysesthesia. Corticosteroid lotions and oral antihistamines did not work on their own but brought additive value when they were used with analgesic agents [ 84 ]. In a case series of 11 patients, one responded completely to treatment of sertraline and hydroxyzine [ 85 ].…”