Scalp Pruritis - Effective Remedies and Management

What Is Scalp Pruritus?

Scalp pruritus is a very common dermatological problem that many people face, in which people have an uncontrollable urge to scratch. It is a therapeutic and diagnostic complication caused by various diseases, also known as itch. This skin condition might be associated with conditions such as seborrheic dermatitis, dermatomyositis, or many other diseases affecting the skin conditions where it might be one of the most frequent treatment-resistant symptoms.

There are usually four variants of this condition: acute or chronic, and generalized or localized. The condition is localized to the scalp region. Due to over-scratching, the complications such as this arise. This condition not only causes physical difficulties but also affects the quality of a person’s life. It is a little tricky to diagnose this condition. In the pathogenesis of this condition cytokines, C nerve fibers, histamine, and cutaneous sensory receptors are involved.

What Is the Classification of Scalp Pruritus?

The following are the classifications of scalp pruritus:

Dermatological Scalp Pruritus: The following are the dermatological disease associated with this type:

1. Inflammatory Disease:

• Psoriasis: It is the skin condition causing itching, rashes, and redness on the skin.

• Red Scalp Disease: It is a very common skin condition that mainly affects the scalp by causing dandruff and skin inflammation.

2. Infectious Dermatoses:

• Scabies: The skin condition caused by mites that burrows into the skin causing itchy skin rashes.

• Tinea Capitis: It is a skin condition caused by ringworm of the scalp.

3. Autoimmune Dermatoses:

• Dermatitis Herpetiformis: It is commonly known as the celiac disease that causes intense itching and blistering on the skin.

4. Bullous Pemphigoid: It is a very rare skin condition affecting aged people. The symptoms of this condition are itchy and bumpy rashes on the skin.

5. Neoplasms:

• Leukemia Cutis: It is a skin condition causing small bumps called papules and large bumps called nodules.

• Lymphoma Cutis: It is the condition that mimics the symptoms of malignant lymphoma. The causes of this condition are mainly idiopathic.

Neuropathic Scalp Pruritus: The following are the dermatological disease associated with this type:

• Atypical Facial Neuralgia: It is a condition where a person has unusual lancinating and burning facial pain.

• Brain and Spinal Cord Injury.

Systemic Scalp Pruritus: The following are the dermatological disease associated with this type:

• Cholestatic Liver Disease: It is a condition caused by primary biliary cirrhosis and primary sclerosing cholangitis.

• Diabetes Mellitus: Condition characterized by uncontrolled sugar levels in the blood.

Psychogenic Scalp Pruritus: The following are the dermatological disease associated with this type:

• Anxiety Disorders: It is a psychological disorder that causes feelings of worry or stress.

• Delusional Parasitosis: It is a psychological disorder that makes people believe that they are infected by bugs, worms or creatures.

• Depression: It is a psychological disorder causing sadness, tearfulness, or emptiness.

• Obsessive Compulsive Disorders: It is a psychological disorder that is represented by repetitive behavioral patterns due to unwanted thoughts and anxiety.

What Are the Causes of Scalp Pruritus?

The following are the etiological factors associated with scalp pruritus:

• Dandruff: It is a skin condition that causes a flakey scalp.

• Diabetes: It is a chronic condition that affects the pancreas’s ability to produce insulin.

• Shingles: It is a viral infection causing painful rashes on the body.

• Allergies: It is a reaction of the body to a foreign substance.

• Anxiety: It is a psychological disorder.

• Contact Dermatitis: It is a rash caused by allergic reactions on the skin.

• Scalp Psoriasis: It is an immunological condition where the skin cells multiply too quickly causing flakey and itchy skin.

• Head Lice: It is a tiny insect that infests the scalp causing itching.

• Migraine: It is a severe type of headache causing throbbing pain in the head.

• Discoid Lupus: It is a very common type of lupus that represents a round skin lesion that is not painful in nature.

• Ringworm: It is a fungal condition of the skin caused by parasites.

What Are the Signs and Symptoms of Scalp Pruritus?

The followings are the signs and symptoms associated with scalp pruritus:

• Bald patches.
• Itching.
• Dry skin.
• Redness.
• Swelling on the scalp.
• Sore scalp.
• Scales or patches of scales on the scalp.
• Low-grade fever.
• Pus-filled sores.

How to Diagnose Scalp Pruritus?

The following techniques are employed in the diagnosis of scalp pruritus:

History Taking: The history taking for this condition includes various steps such as:

• Ask for information about the onset of the first symptoms.
• Ask if other areas are affected other than the scalp.
• Ask about the severity of the symptoms.
• Ask about the alleviating factors of the condition.
• Ask about the medical history of the patient.

Use the visual analog scale to check the intensity of the condition. The scale shows the result from 0 to 10 depending on the severity of the condition.

Physical Examination: This part of the diagnosis focuses on the dermatological symptoms related to the skin and scalp. During this diagnostic step, the dermatologist determines the primary and secondary lesions, which play an important role in determining the underlying condition. The secondary lesion is determined by signs such as scratching and rubbing, which are the determining factors in the course of chronic disease.

Investigation: If the dermatologist is unable to conclude or determine the condition after history taking and physical examination, this step is followed after that. Doctors usually go for an initial laboratory investigation with the following methods:

• Complete blood count.
• Blood urine nitrogen.
• Creatinine level.
• Bilirubin level.
• Alkaline phosphatase level.
• Thyroid-stimulating hormone.
• Fasting plasma glucose level.

After this initial investigation, doctors go for the following tests:

• Skin scraping and culture.
• Skin biopsy.
• Antinuclear antibody.
• Anti-hepatitis C virus antibody.
• Anti-human immunodeficiency virus antibody.
• Chest X-ray.

How to Manage Scalp Pruritus?

Scalp pruritus can be managed with the following methods.

Topical Therapy:

• Glucocorticoids available in lotion, gel, or foam type. Side effects are skin atrophy, folliculitis, and telangiectasia.

• Calcineurin inhibitors- Pimecrolimus - one percent. Stinging and burning sensation are the side effects.

• Tacrolimus- 0.03 % to 0.1 %. Stinging or burning sensation are the common side effects.

• Menthol- one percent to five percent. Skin irritation is seen.

• Capsaicin- 0.025 % - 0.1 %. Burning sensation is seen.

• Liquor carbonic detergents- three percent to ten percent. Skin irritation, stinging sensation are common side effects.

• Shampoos with anti-inflammatory effects: Shampoos containing Zinc pyrithione, Ketoconazole, selenium sulfide, or coal tar. Skin irritation and scalp dryness are seen.

Systemic Therapy:

• Antihistamines - 4 to 16 milligrams per day orally. Drowsiness and dry mouth are common side effects.

• Chlorphenamine, Hydroxyzine, 25 to 50 milligrams per day orally. Drowsiness and dry mouth are side effects

• Diphenhydramine, Cetirizine, 10 to 20 milligrams per day orally. Drowsiness and dry mouth are seen.

• Doxepin, 25 to 100 milligrams per day orally. Drowsiness, dry mouth, and prolonged QT interval are commonly observed.

• Anticonvulsants - Gabapentin, 100 to 1200 milligrams per day orally. The side effects include drowsiness, leg edema, and constipation.

• Opioids - Naloxone - 0.2 milligrams per kilogram per minute intravenous daily, preceded by 0.4 mg intravenous bolus over 24 hours. Hepatotoxicity, nausea and vomiting, and insomnia are commonly felt.

• Antidepressants - Amitriptyline, 10 to 150 milligrams per day orally. Drowsiness, dizziness, dry mouth, and constipation are mostly seen.

Phototherapy: Dermatologists usually go for phototherapy using ultraviolet rays for patients with pruritus. This therapy provides anti-inflammatory effects, antiproliferative effects, and minimal adverse effects on mast-cell apoptosis. Although there are no cases suggestive of this treatment option for the cure of pruritus, the use of an ultraviolet-light comb has proved to be very effective targeted phototherapy for this condition.

Psychotherapy: For cases where a person has an uncontrollable urge for scratching and rubbing, psychotherapy is required to break the urge using various therapeutic modes. This not only helps in improving the symptoms of this condition, but sometimes it addresses the underlying condition causing pruritus in the patients.

Conclusion

Scalp pruritus is a very common skin condition. Due to various etiological factors, it is a bit tricky to diagnose the cause of the condition. Moreover, the management of scalp pruritus needs constant and regular drug therapy and regular follow-ups. The effects of the condition are not limited to only physical complications, there are many psychological effects associated with this condition.