Trichodynia refers to the painful sensation of the scalp related to the complaint of hair loss. Originally suggested to be distinguishing for telogen effluvium and related to hair loss activity and follicular inflammation, further studies have found trichodynia to be common in androgenetic alopecia as well and coexisting with psychopathologic findings. The respective studies failed to demonstrate correlations between trichodynia and quantifiable hair loss activity, nor histopathologic evidence for follicular inflammation. A symptomatic scalp is a frequent condition in specific dermatological conditions of the scalp. By definition of exclusion, we are not dealing with trichodynia in these cases. It is conceivable that neuropeptides are key players between the central nervous system and the skin immune and microvascular system. Such mechanisms would explain the noxious effects of both external stimuli and emotional distress in eliciting cutaneous nociception. Since we have begun to understand the diverse etiologies of trichodynia, and a single term does not measure up to this circumstance, it may be wiser to describe the condition depending on the type of scalp sensation and its specific disease association. Further studies are warranted into the neural/endothelial/follicular interactions both in hair growth and shedding and the psychosomatic diseases of the hair and scalp.

1.
Askin
O
,
Gok
AM
,
Serdaroglu
S
.
Presence of trichodynia symptoms in hair diseases and related factors
.
Skin Appendage Disord
.
2021
;
7
(
1
):
18
20
. .
2.
Rebora
A
,
Semino
MT
,
Guarrera
M
.
Trichodynia (letter)
.
Dermatology
.
1996
;
192
:
292
3
.
3.
Fox
H
.
Alopecia and severe parasthesia of scalp, associated with amenorrhea
.
Arch Derm Syphilol
.
1946 Dec
;
54
(
6
):
725
.
4.
Sulzberger
MB
,
Witten
VH
,
Kopf
AW
.
Diffuse alopecia in women. Its unexplained apparent increase in incidence
.
Arch Dermatol
.
1960
;
81
:
556
60
. .
5.
Grimalt
R
,
Ferrando
J
,
Grimalt
F
.
Trichodynia (letter)
.
Dermatology
.
1998
;
196
:
374
.
6.
Willimann
B
,
Trüeb
RM
.
Hair pain (trichodynia): frequency and relationship to hair loss and patient gender
.
Dermatology
.
2002
;
205
:
374
7
. .
7.
Ludwig
E
.
Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex
.
Br J Dermatol
.
1977
;
97
:
247
54
. .
8.
Rushton
DH
,
Ramsay
ID
,
James
KC
,
Norris
MJ
,
Gilkes
JJ
.
Biochemical and trichological characterization of diffuse alopecia in women
.
Br J Dermatol
.
1990
;
123
:
187
97
. .
9.
Rushton
DH
,
Ramsay
ID
.
The importance of adequate serum ferritin levels during oral cyproterone acetate and ethinyl oestradiol treatment of diffuse androgen-dependent alopecia in women
.
Clin Endocrinol
.
1992
;
36
:
421
7
. .
10.
Kivanç-Altunay
I
,
Savaş
C
,
Gökdemir
G
,
Köşlü
A
,
Ayaydin
EB
.
The presence of trichodynia in patients with telogen effluvium and androgenetic alopecia
.
Int J Dermatol
.
2003
;
42
(
9
):
691
3
. .
11.
Reich
A
,
Mędrek
K
,
Adamski
Z
,
Szepietowski
JC
.
Itchy hair-trichoknesis: a variant of trichodynia or a new entity?
Acta Derm Venereol
.
2013
;
93
(
5
):
591
.
12.
Hoss
D
,
Segal
S
.
Scalp dysesthesia
.
Arch Dermatol
.
1998
;
134
:
327
30
. .
13.
Cotterill
JA
.
Dermatologic nondisease
.
Dermatol Clin
.
1996
;
14
(
3
):
439
45
. .
14.
Maffei
C
,
Fossati
A
,
Rinaldi
F
,
Riva
E
.
Personality disorders and psychopathologic symptoms in patients with androgenetic alopecia
.
Arch Dermatol
.
1994
;
130
(
7
):
868
72
. .
15.
Rebora
A
.
Trichodynia: a review of the literature
.
Int J Dermatol
.
2016
;
55
(
4
):
382
4
.
16.
Whiting
DA
.
Chronic telogen effluvium: increased scalp hair shedding in middle-aged women
.
J Am Acad Dermatol
.
1996
;
35
:
899
906
. .
17.
Whiting
DA
.
Diagnostic and predictive value of horizontal sections of scalp biopsy specimens in male pattern androgenetic alopecia
.
J Am Acad Dermatol
.
1993
;
28
:
755
63
. .
18.
Griggs
J
,
Trüeb
RM
,
Gavazzoni Dias
MFR
,
Hordinsky
M
,
Tosti
A
.
Fibrosing alopecia in a pattern distribution
.
J Am Acad Dermatol
.
2020 Jan 820
;
S0190-9622
:
30030
X
. .
19.
Bin Saif
GA
,
McMichael
A
,
Kwatra
SG
,
Chan
YH
,
Yosipovitch
G
.
Central centrifugal cicatricial alopecia severity is associated with cowhage-induced itch
.
Br J Dermatol
.
2013
;
168
(
2
):
253
6
.
20.
Rebora
A
.
Telogen effluvium: a comprehensive review
.
Clin Cosmet Investig Dermatol
.
2019 Aug 21
;
12
:
583
90
.
21.
Rebora
A
.
Alopecia areata incognita: a hypothesis
.
Dermatologica
.
1987
;
174
:
214
8
. .
22.
Braun-Falco
,
Zaun
O
.
Über die Beteiligung des gesamten Capillitiums bei Alopecia areata
.
Hautarzt
.
1962
;
13
:
342
8
.
23.
Moftah
NH
,
El-Barbary
RA
,
Rashed
L
,
Said
M
.
ULBP3: a marker for alopecia areata incognita
.
Arch Dermatol Res
.
2016
;
308
(
6
):
415
21
. .
24.
Dutra Rezende
H
,
Reis Gavazzoni Dias
MF
,
Trüeb
RM
.
Alopecia areata incognita: an oxymoron?
Arch Dermatol Res
.
2021 Mar 1
.
25.
Tosti
A
,
Piraccini
BM
,
van Neste
DJ
.
Telogen effluvium after allergic contact dermatitis of the scalp
.
Arch Dermatol
.
2001
;
137
:
187
90
.
26.
Thornsberry
LA
,
English
JC
 3rd
.
Scalp dysesthesia related to cervical spine disease
.
JAMA Dermatol
.
2013
;
149
(
2
):
200
3
. .
27.
Lee
JL
,
Morillo-Hernandez
C
,
Agarwal
V
,
Standaert
CJ
,
English
JC
 3rd
.
Cervical spine imaging and treatment outcomes in scalp dysesthesia: a retrospective cohort study
.
J Am Acad Dermatol
.
2020 Aug 7
;
S0190-9622
(
20
):
32364
1
.
28.
Daly
T
,
Daly
K
.
Telogen effluvium with dysesthesia (TED) has lower B12 levels and may respond to B12 supplementation
.
J Drugs Dermatol
.
2018
;
17
(
11
):
1236
40
.
29.
Hocking
B
,
Westerman
R
.
Neurological changes induced by a mobile phone
.
Occup Med
.
2002
;
52
(
7
):
413
5
. .
30.
Xerfan
EMS
,
Andersen
,
Facina
AS
,
Tufik
S
,
Tomimori
J
.
The role of sleep in telogen effluvium and trichodynia: a commentary in the context of the current pandemic
.
J Cosmet Dermatol
.
2021 Jan 2
.
31.
Trüeb
RM
,
Dutra Rezende
H
,
Gavazzoni Dias
MFR
.
What can the hair tell us about COVID-19?
Exp Dermatol
.
2021
;
30
(
2
):
288
90
. .
32.
Wei
KC
,
Huang
MS
,
Chang
TH
.
Dengue virus infects primary human hair follicle dermal papilla cells
.
Front Cell Infect Microbiol
.
2018
;
8
:
268
. .
33.
Ericson
M
,
Gabrielson
A
,
Worel
S
,
Lee
WS
,
Hordinsky
MK
.
Substance P (SP) in innervated and non-innervated blood vessels in the skin of patients with symptomatic scalp
.
Exp Dermatol
.
1999
;
8
(
4
):
344
5
.
34.
Rakowska
A
,
Olszewska
M
,
Rudnicka
L
.
Trichoscopy of scalp dysesthesia
.
Postepy Dermatol Alergol
.
2017
;
34
(
3
):
245
7
. .
35.
Panconesi
E
,
Hartmann
G
.
Psychophysiology of stress in dermatology. The psychologic pattern of psychosomatics
.
Dermatol Clin
.
1996
;
14
:
399
421
.
36.
Arck
PC
,
Handjiski
B
,
Hagen
E
,
Joachim
R
,
Klapp
BF
,
Paus
R
.
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
(
13
):
2536
8
. .
37.
Vallerand
AH
,
Polomano
RC
.
The relationship of gender to pain
.
Pain Manag Nurs
.
2000
;
1
(
3 Suppl 1
):
8
15
. .
38.
Davis-Daneshfar
A
,
Trüeb
RM
.
Tonsural trichotillomania (article in German)
.
Hautarzt
.
1995
;
46
(
11
):
804
7
.
39.
Trüeb
RM
.
From Hair in India to Hair India
.
Int J Trichology
.
2017
;
9
(
1
):
1
6
.
40.
Kinoshita-Ise
M
,
Shear
NH
.
Diagnostic and therapeutic approach to scalp dysesthesia: a case series and published work review
.
J Dermatol
.
2019
;
46
(
6
):
526
30
. .
41.
Trüeb
RM
.
North American Virginian witch hazel (Hamamelis virginiana)-based scalp care and protection for sensitive scalp, red scalp, and scalp burn-out
.
Int J Trichology
.
2014
;
6
(
3
):
100
3
.
42.
Gazerani
P
,
Au
S
,
Dong
X
,
Kumar
U
,
Arendt-Nielsen
L
,
Cairns
BE
.
Botulinum neurotoxin type A (BoNTA) decreases the mechanical sensitivity of nociceptors and inhibits neurogenic vasodilation in a craniofacial muscle targeted for migraine prophylaxis
.
Pain
.
2010
;
151
(
3
):
606
16
. .
43.
Mathew
NT
,
Kailasam
J
,
Meadors
L
.
Predictors of response to botulinum toxin type A (BoNTA) in chronic daily headache
.
Headache
.
2008
;
48
(
2
):
194
200
. .
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