Scientific Area

Scalp pain

CATEGORIES SCIENTIFIC AREA

Scientific collaboration between Professor Marco Toscani and Dr. Pasquale Fino, Chair of Plastic, Reconstructive and Aesthetic Surgery, Umberto I Health Center – “Sapienza” University of Rome.

Scalp pain and irritation (or trichodynia) are pathological conditions that affect both women (in a greater percentage) and men (in a lower percentage). The pain felt on the scalp, spontaneous or caused by treatment, and in particular around the roots of the hair, may be more or less intense, alternating at times between periods of disappearance, associated with burning, tingling or itching.

Usually, this particular scalp condition does is not located in a specific area and increases when hair is touched or brushed. Often, trichodynia is associated with hair loss. A correlation can be found between telogen effluvium and trichodynia and between seborrheic hair loss and the constant sensation of scalp pain or irritation.
Trichodynia is classified among the allodynia, conditions in which pain is felt on the skin without recognizable external causes or appears to be caused by usually innocuous stimuli. Patients suffering from this condition perceive a burning sensation and irritation on the scalp. The itchiness is so intense that thay are forced to scratch their head. The relief however is very short-lasting.
The reduction of the activation threshold of nerve endings (nociceptors), whose endings spread over the entire scalp (the pilosebaceous apparatus of each hair and the correspondent nerve endings at the level of the skin), seems to have a decisive role in triggering allodynia. The inflammation of the skin activates the nociceptors that secrete neuropeptide P, the neurotransmitter of pain. Individuals who notice this condition tend to scratch their head, pull out their hair hair to feel mild relief, but this leads to hair loss due to trichotillomania.
Although the (aforementioned) chemical process that causes skin inflammation is now known, the causes are still unclear, namely what triggers this process and how the nociceptors act. There is a strong correlation between the emotional component and trichodynia and between trichodynia and hair loss. Nervousness, stress and anxiety are associated with the appearance of scalp pain and itchiness, and with subsequent hair loss.

Another cause that triggers pain is hyperseborrhea, which leads to seborrheic dermatitis and the appearance of pain, inflammation and skin irritation. Another cause is greasy dandruff, which irritates the scalp, damaging follicular activity. Other possible causes of pain are scalp folliculitis and acne that lead to rashes, pain and itchy skin.
During the inflammatory process, the fact that the muscles of the arrector pili of the hair are forced into a strange position for long period of time may cause pain. The arrector pili muscles and the hair follicles may then become inflamed, thereby triggering the inflammatory process of the skin. Another cause of trichodynia may be neuro-muscular inflammation of skin overstressed by the tendency to grind one’s teeth, especially at night (bruxism), with the subsequent contraction of the temporomandibular joint that, with the passing of time, may involve the cranial muscles, causing headaches and trichodynia. Trichodynia should be cared for and countered with trichological treatments that aim to eliminate the underlying causes, such as hyperseborrhea and dandruff. The use of lotions and shampoos that cleanse the skin of impurities and bacteria that cause inflammation and conseuquent pain is recommended. It is also important to use remedies against hair loss.

Suitable specific and personalized therapies should be used only after a careful examination of the hair and a scrupulous skin analysis. The following treatments have proven to be useful:

1) the use of laser treatments that increase the blood capillary vasodilation necessary for providing sustenance to hair bulbs

2) treatments with high frequency rays that clean, cleanse and disinfect the scalp, improving blood supply and stimulating healthy hair growth

3) hair massages that allow follicles to expel a small amount of sebum that accumulates and facilitates the relaxation of the skin and scalp muscles.

Hair loss (telogen effluvium)

The term Telogen Effluvium was introduced for the first time by Kligman (*) in 1961 to introduce an acute hair loss of benign origin that follows an intense and short period of stress of different types. Subsequently, Rebora (**) introduced the concept of chronic Telogen Effluvium.

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Grey hair

In the trichological field, with the passing of age hair whitening is seen to follow the greying process of the hair on the scalp (called grey hair). Hair becomes grey (white) following a natural biological aging process of the melanocytes, which are the cells tasked with coloring hair.
In the majority of people, the first grey hairs appear around 35/40 years of age in women and around 30/35 in men.

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Female hair loss

Female hair loss is a common form of non-scarring hair loss, characterized by the progressive loss of hair in the forehead and crown regions, resulting in visible thinning. Unlike male hair loss, female hair loss in the affected areas is usually incomplete and the occipital area is generally spared.

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Life cycle of hair

The life cycle of hair and its subsequent growth occur at a speed of 1-1.5 cm per month. Hair is a living element that follows a follicle cycle with an average duration of 2-6 years. In humans, unlike other mammals that are subject to a periodic change, this cyclic evolution is not synchronous (therefore each hair is independent from the others).

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Hair types and morphology

Some parameters and characteristics should be taken into consideration when assessing hair types and morphologies: shape, density and appearance. The appearance of hair, in the form of lanugo, occurs during the fourth month of pregnancy.

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Structure and chemical composition of hair

The hair on our bodies has a particular structure and is divided into thin and thick hair. Thin hair, also called lanugo or vellus, is located on all skin surfaces except for the palms of the hands and the soles of the feet. Thick hair, also called terminal hair, is dark and located only in some areas such as the scalp, the armpits, the pubic area, the beard area in the case of men, etc…

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