The cause of burning scalp syndrome is not known and has not been investigated in detail.
However, there is some preliminary research and much speculation that changes in the production and activity of neuropeptides in the skin may play a role in hair loss.There is some evidence for an interaction between neuropeptides produced by neurons in the skin and hair follicles cycle.In particular, skin and hair follicle concentrations of a factor called “substance P” fluctuate with the growth and rest of hair follicles. Substance P hair loss can initiate pain sensations.
In principle, it may be that as the hair follicles are negatively affected in a hair loss disease and more of the follicles enter a telogen resting state the levels of substance P or similar neuropeptides in the skin significantly increases.The result is that there is a stinging of the scalp in the context that hair loss progresses.Alternatively, hair loss may involve increased inflammatory cell activity which can be quite common in hereditary hair loss. But much less so in telogen effluvium.
A third explanation for scalp pain has been proposed based on an underlying mental disorder in the affected individual.
Burning scalp syndrome is apparently treated with any dermatologist with tricyclic antidepressants.
Although these are commonly used to treat hair loss and depression and other similar disorders, it has also been shown that antidepressants reduce the production of substance P.
Thus anti depressants can work by directly reducing the levels of substance P in the skin and thus reducing local pain sensations.
Other suggested treatments have included non-irritating shampoo for hair loss, topical antipruritic or anesthetic, topical capsaicin, and corticosteroids.
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