Scalp Dysesthesia: Emerging Pathophysiologic Insights and Therapeutic Implications

Scalp dysesthesia is a poorly understood condition characterized by chronic scalp pruritus and pain in the absence of underlying cutaneous disease. Delayed diagnosis, limited clinician awareness, and inconsistent therapeutic responses continue to complicate management. This scoping review aimed to synthesize current evidence regarding the clinical presentation, diagnosis, and treatment of scalp dysesthesia. A comprehensive review of the literature was conducted, with data extracted from 20 studies describing 59 patients, the majority of whom were middle-aged and older women. Common comorbidities included spinal musculoskeletal pathology and psychiatric conditions. Collectively, the clinical findings and evolving understanding of neuronal signaling support a potential neuropathic component to scalp dysesthesia, likely influenced by both physiologic factors, such as inflammation, hormonal changes, and aging, and psychological contributors including anxiety and depression. Diagnosis requires extensive evaluation to exclude differential diagnoses and typically involves patient history, physical examination, imaging, and laboratory investigations. Frequently reported management strategies included corticosteroids, antibiotics/antifungals, antidepressants, and gabapentinoids, although treatment efficacy was inconsistent between patients. Preliminary observations suggest that emerging therapies, such as exercise-based interventions, onabotulinumtoxin A, pain receptor antagonists, surgery, and biologics, may have potential benefits; however, evidence remains limited by small sample sizes. Further work is needed to standardize diagnostic approaches, improve clinician awareness, clarify pathogenesis, and establish evidence-based, mechanism-driven treatment strategies for scalp dysesthesia.