Dermatology Update on the Challenging Trichodynia

Trichodynia is the sensation of pain in the scalp, which, in most cases, is associated with certain types of alopecia. Despite being a term coined by Rebora back in 1996 to described patients with diffuse alopecia consistent with telogen effluvium, this symptom has currently been reported in other entities. Androgenic alopecia, scarring alopecia, alopecia areata, trichotillomania, and chemotherapy-induced alopecia are common causes of trichodynia. Similarly, its association with psychiatric comorbidities, including depression, anxiety, obsessive-compulsive disorder and somatoform disorders has been reported with a higher prevalence among women. Although its pathogenesis is still to be elucidate, some factors involved are substanceP, psychiatric comorbidities and perifollicular inflammation. Clinically it exhibits pain or discomfort of the scalp, almost always in association with hair los. The sensation of pain can occur throughout the scalp or locally in some specific areas. Diagnosis is clinical and one of exclusion. Regarding treatment, there are no specific therapies for trichodynia. However, the use of botulinum toxinA, antidepressants, neuromodulators, propranolol, topical corticosteroids, oral corticosteroids and topical cannabinoids are therapeutic alternatives that should be taken into consideration. Since treatment of trichodynia is still therapeutically challenging for dermatologists more prospective studies are needed to evaluate new therapies.