Background: Patients complaining of hair loss frequently claim that their hair has become painful. Objective and Methods: The aim of the study was to evaluate the frequency of this phenomenon and its relationship to hair loss. Patients seeking advice for hair loss either spontaneously reported or were questioned about painful sensations of the scalp. Hair loss activity was quantified by a hair pull, daily count and wash test. Telogen percentage was obtained by a hair pluck. The scalp surface was examined by dermatoscopy. Results: Of 403 examined patients, 20% of women and 9% of men reported hair pain, irrespective of the cause and activity of hair loss. A minority presented scalp telangiectasia. This strongly correlated with hair pain. Conclusions: Hair pain (trichodynia) affects a significant proportion of patients complaining of hair loss and may increase the anxiety. The symptom neither allows discrimination of the cause nor correlates with the activity of hair loss. A higher prevalence of female patients might be connected to gender-related differences in pain perception in relation to anxiety. The role of vasoactive neuropeptides in the interaction between the central nervous system and skin reactivity is discussed. In the absence of any correlation with quantitative parameters of hair loss or specific morphologic changes of the scalp, management remains empiric and tailored to the individual.

Keywords:
Hair pain, Female gender, Scalp telangiectasia, Neuropeptide substance P
1.
Rebora A, Semino MT, Guarrera M: Trichodynia (letter). Dermatology 1996;192:292–293.
2.
Grimalt R, Ferrando J, Grimalt F: Trichodynia (letter). Dermatology 1998;196:374.
3.
Trüeb RM: Trichodynie. Hautarzt 1997;48:877–880.
4.
Trüeb RM: Telogen effluvium and trichodynia (letter). Dermatology 1998;196:374–375.
5.
Jaworsky C, Kligman AM, Murphy GF: Characterization of inflammatory infiltrate in male pattern alopecia: Implications for pathogenesis. Br J Dermatol 1992;127:239–246.
6.
Ericson M, Gabrielson A, Worel S, et al: Substance P (SP) in innervated and noninnervated blood vessels in the skin of patients with symptomatic scalp. Exp Dermatol 1999;8:344–345.
7.
Hoss D, Segal S: Scalp dysesthesia. Arch Dermatol 1998;134:327–330.
8.
Hua AS, Thomas GW, Kincaid-Smith P: Scalp tingling in patients on labetalol. Lancet 1977;ii:295.
9.
Rebora A: Telogen effluvium. Dermatology 1997;195:209–212.
10.
Guarrera M, Semino MT, Rebora A: Quantitating hair loss in women: A critical approach. Dermatology 1997;194:12–16.
11.
García-Hernández MJ, Camacho FM: Chronic telogen effluvium: Incidence, clinical and biochemical features, and treatment. Arch Dermatol 1999;135:1123–1124.
12.
Rebora A, Semino MT, Guarrera M: Reply to Trüeb [4] (letter). Dermatology 1998;196:374–375.
13.
Mahe YF, Michelet JF, Billoni N, et al: Androgenetic alopecia and microinflammation. Int J Dermatol 2000;39:576–584.
14.
Lonne-Rahm SB, Fischer T, Berg M: Stinging rosacea. Acta Derm Venereol 1999;79:460–461.
15.
Burstein R, Cutrer MF, Yarnitsky D: The development of cutaneous allodynia during a migraine attack: Clinical evidence for the sequential recruitment of spinal and supraspinal nociceptive neurons in migraine. Brain 2000;123:1703–1709.
16.
Panconesi E, Hartmann G: Psychophysiology of stress in dermatology: The psychologic pattern of psychosomatics. Dermatol Clin 1996;14:399–421.
17.
Arck PC, Handjiski B, Hagen E, et al: Indications for a ‘brain-hair follicle axis (BHA)’: Inhibition of keratinocyte proliferation and up-regulation of keratinocyte apoptosis in telogen hair follicles by stress and substance P. Faseb J 2001;15:2536–2538.
18.
Rollman GB, Lautenbacher S, Jones KS: Sex and gender differences in responses to experimentally induced pain in humans: Sex, gender, and pain; in Fillingim RB (ed): Progress in Pain Research and Management. Seattle, IASP Press, 2000, vol 17.
19.
Sanderson KV: Tonsure trichotillomania. Br J Dermatol 1970;82:343–350.
20.
Kramer MS, Cuttler N, Feighner J, et al: Distinct mechanism for antidepressant activity by blockade of central substance P receptors. Science 1998;281:1640–1645.
© 2002 S. Karger AG, Basel
2002
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