Patients who were depressed benefited from fluoxetine therapy. In its most common form, alopecia areata causes small round or oval patches of baldness on the scalp. Continued research into the chronic pain syndromes now suggests that they may represent a neurologic dysfunction that in some cases is associated with a secondary psychiatric component.  M Dysesthetic (‘essential') vulvodynia: treatment with amitriptyline. These women experienced debilitating scalp pain and/or pruritus. We describe 11 women with scalp dysesthesia, a condition that we believe is a type of chronic cutaneous dysesthesia.  HJed Psychocutaneous disease. Watson Prior somatization was present in 3 patients. Sulzberger Thus, our patients do not have an increased incidence of AGA compared with the general population. We comply with the HONcode standard for trustworthy health information -, Look up ICD10 codes for Alopecia on, You suddenly develop a bald spot on your scalp, Your hair stylist tells you that your hair is thinning, or that you have small bald areas, You have lost your eyebrows or eyelashes, your beard is thinning, or you have noticeably less hair on your underarms or pubic area. "9 Many of the chronic pain syndromes were initially thought to represent a psychiatric disorder only. Despite treatment, about 7% of people experience prolonged large areas of hair loss with little hair regrowth. In the future, this drug may prove to be a useful adjunctive therapy for managing a variety of chronic pain syndromes, including scalp dysesthesia. The risk of developing alopecia areata is unusually high in people who have asthma, hay fever, thyroid disease, vitiligo (a condition in which patches of skin lose their color), pernicious anemia and Down syndrome. Gabapentin, a newly released anticonvulsant medication, has been effective in treating chronic pain syndromes (erythromelalgia19 and reflex sympathetic dystrophy20) in uncontrolled studies. We describe 11 patients with a new syndrome that we term scalp dysesthesia. Venning  B The pathophysiology of pain. Background   SAMuir  MBLynch We included those patients with only pruritus for several reasons: first, several patients with pain or burning reported coexisting pruritus or initial transient pruritus; second, there appeared to be a spectrum of complaints ranging from pain only, to pain and pruritus, to pruritus only; and third, the degree of interference with daily life seemed similar in all patients regardless of their specific symptom. Headington  J Amitriptyline versus placebo in postherpetic neuralgia. When queried, all patients stated that their pain did not resemble a headache. All Rights Reserved. For some people, however, the problem can last longer and be more severe, causing total baldness (alopecia totalis) or total loss of body hair (alopecia universalis). Also topical minoxidil (Rogaine) may increase hair growth by accelerating the speed of the natural hair cycle and increasing the diameter of hairs that begin to grow. Temporal arteritis and tension headaches are underlying medical conditions with symptoms that may include scalp pain or tightness. Five women had physician-diagnosed psychiatric disorders, including dysthymic disorder, generalized anxiety, and somatization. New bald patches can develop at the same time older ones are regrowing hair. Dr. Ward Bond's Vitamin, Mineral & Antioxidant Guide. articles, blogs and more - and Prizes, too! Koblenzer and Bostrom2 coined the term "chronic cutaneous dysesthesia syndrome" to refer to patients whose primary cutaneous complaint is dysesthesia. Dysesthesia can be defined as "a disagreeable sensation present with ordinary stimuli. Five women had physician-diagnosed psychiatric disorders, including dysthymic disorder, generalized anxiety, and somatization. One patient responded completely to treatment with sertraline and hydroxyzine hydrochloride but then experienced a relapse. The patients ranged in age from 36 to 70 years. Hi all, I have trichodynia (burning scalp) for 6 months now. Cotterill The positive response to therapy supports our belief that scalp dysesthesia represents a chronic pain syndrome or a subset of the cutaneous dysesthesia syndrome.  JA Dermatological non-disease: a common and potentially fatal disturbance of cutaneous body image. Alopecia areata is a skin disorder that causes hair loss, usually in patches, most often on the scalp. Lynch  RJReed Several placebo-controlled studies have documented the efficacy of low-dose antidepressants for treating chronic pain. Eight women experienced improvement or complete resolution of symptoms with treatment with low-dose doxepin hydrochloride or amitriptyline hydrochloride. Max However, one must be cautious when reviewing data describing a personality profile or a psychiatric disorder associated with any chronic condition, particularly a painful one.3,13 Is a psychiatric disturbance (ie, depression) the cause of chronic pain or does experiencing chronic pain result in symptoms of depression? Burning scalp syndrome, also known as trichodynia, is a condition characterized by pain, tingling, and burning of the scalp . Cutaneous dysesthesia syndrome is a disorder characterized by chronic cutaneous symptoms without objective findings.  MBernhard First to create the only oral nutritional program for Interstitial Cystitis. Feinmann Fluoxetine had no greater analgesic effect than placebo in nondepressed patients. About 60% of people with alopecia areata experience the first episode of hair loss before age 20. In a retrospective review, McKay18 reported that dysesthetic (essential) vulvodynia responds to treatment with low-dose amitriptyline. Terms of Use| Customize your JAMA Network experience by selecting one or more topics from the list below.  JT Telogen effluvium: new concepts and review.  MBWitten The area of bald skin looks smooth and normal. Conclusions  All Rights Reserved, Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, United States Preventive Services Task Force, 1998;134(3):327-330. doi:10.1001/archderm.134.3.327. Treatment of her scalp burning with doxepin hydrochloride resulted in cessation of burning and decreased daily hair loss on both occasions.  MCawley None of our patients exhibited signs of psoriasis or seborrheic dermatitis that might have caused their symptoms. Accessibility Statement. Genetic (inherited) factors may play a role, too, particularly when the disorder strikes those under age 30. Eleven women presented with chronic severe pain and/or pruritus of the scalp only without objective physical findings, a condition we term "scalp dysesthesia." It is definitely based on my huge anxiety-depression and doesn't seem to get better without the use of anti-anxiety drugs. Usually, the bald patches appear suddenly and affect only a limited area. If there is still doubt as to diagnosis, a small skin biopsy of your scalp may confirm the diagnosis. Five women described pain, stinging, or burning only; 4 women complained of pain and pruritus; and 2 women reported pruritus only.  GVikkula We acknowledge Jean Vogel, MD, for performing psychiatric evaluations of 2 of our patients and Peter Lynch, MD, for providing helpful suggestions regarding therapy with low-dose antidepressants. Bowers Make an appointment to see your doctor if: In more than 90% of cases, hair grows back and fills the bald spot within one year, even without treatment. Arch Dermatol. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records.  VHKopf  SESmoller McKay Some people with the condition will respond to high dose topical preparations applied to the affected areas. It is usually followed by hair regrowth. Although there is no permanent cure for alopecia areata, there are ways that may short-circuit the body's autoimmune reaction in the scalp and encourage hair regrowth. Your doctor will usually be able to diagnose alopecia areata based on examination of the areas of your hair loss and your symptoms. Patient 7 responded to therapy for 1 year but then had a relapse.  JShoaf  CSBostrom Patients complain of burning, stinging, or itching, which is often triggered or exacerbated by psychological or physical stress.  RPR Patterned androgenic alopecia in women. Feinmann  AW Diffuse alopecia in women.  SLedHurley To look for further evidence, your doctor may pull gently on the hairs near the edge of the bald area to determine whether these hairs come out very easily and to inspect them for any structural abnormalities of the root or shaft. In its most common form, alopecia areata causes small round or oval patches of baldness on the scalp. Patient 9 (with pruritus only) was not responsive to numerous therapies including several antidepressants.

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