PS20 Scalp sensations and psychological distress in nonscarring and scarring alopecias

Abstract

Alopecias, especially nonscarring forms, are considered dermatological disorders with low subjective symptoms. However, trichodynia – a painful scalp sensation – is common with telogen effluvium and androgenetic alopecia (AGA), often coexisting with psychopathological findings. Scarring alopecias, such as lichen planopilaris (LPP), may present with pruritus. We evaluated the prevalence of subjective scalp sensations in alopecias and examined their associations with psychological distress. Ninety patients were enrolled. Their mean age was 38.3 years; 39 had AGA, 22 had alopecia areata (AA) and 29 had LPP. Scalp sensations were evaluated using the Hair-Specific Skindex-29, which is rated on a five-point Likert scale from 0 = ‘never’ to 4 = ‘all the time’, transformed to a 0–100 scale. Prevalence was defined as the proportion of patients reporting a score > 0 for items 1 (scalp hurting), 7 (burning/stinging) and 10 (itch). Psychological distress was measured with the Hospital Anxiety and Depression Scale. Simple linear regression analyses were performed. Scalp hurting sensation was reported by 56% of patients with AGA (mean score 33.3, SD 34.6), 45% of patients with AA (mean 34.1, SD 40.5) and 55% of patients with LPP (mean 21.6, SD 22.9). Burning/stinging occurred in 33% of patients with AGA (mean 14.7, SD 24.1), 32% with AA (mean 20.5, SD 31.5) and 34% with LPP (mean 11.2, SD 17.1). Itch prevalence was 51% in AGA (mean 25.0, SD 30.9), 45% in AA (mean 23.9, SD 31.3) and 55% in LPP (mean 24.1, SD 27.1). Linear regression analysis showed significant associations between burning sensation and distress in LPP (R2 = 0.18, P = 0.02) and AGA (R2 = 0.11, P = 0.04), but not for scalp hurting or itch. Contrary to the common view that nonscarring alopecias are largely asymptomatic, the prevalence of subjective scalp sensations – particularly hurting and burning – was comparable with that in scarring LPP. The selective link between burning and psychological distress suggests a specific psychoneuroinflammatory pathway, although it explains only part of the symptoms.