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JOURNAL READING

SCALP ITCH:
A SYSTEMATIC REVIEW

RATIH ANINDITA RAHAJENG R


ABSTRACT
 Scalp itch is a frequent complaint in the dermatological
setting
 It is common for the dermatologist to encounter patient with
no evident cause of scalp pruritus, making it a distressing
situation for both the clinician and the patient.
 The aim of this article is to purpose a systematic approach to
scalp itch, which classifies scalp pruritus into two types; with
or without dermatological lesions, and presence or absence
of hair loss
 The acronym SCALLP and the five steps for scalp evaluation
(listen, look, touch, magnify, and sample) are useful tools to
keep in mind for an assertive approach in these patients
introduction

 Itch, by definition, is the presence of an


uncomfortable tingling or uneasy sensation,
which is associated with a desire to scratch
 Just like skin pruritus, its etiology may be of
dermatological or non dermatological origin
 The aim of this article is to review the clinical
signs of the most common causes of scalp
itch and other less common causes that must
be considered in a systematic approach to
scalp pruritus
A partical method to classify scalp itch
is to consider two types:
(1) with dermatological lesions
Patient Examination - Scalp itch with scalling/erythema
For evaluating scalp itch, - Seborrheic Dermatitis
we can follow the five steps - Psoriasis
proposed by Shapiro and - Contact dermatitis
Otberg for evaluation of - Red Scalp Syndrome
hair loss: listen, look, - Tinea capitis
- Dermatomyositis
touch, magnify, and sample, - Sensitive Scalp/Atopic dermatitis
while focusing on scalp itch - Urticaria lesions
- Infestations
- Other skin lesions
(2) Without skin lesions
- Neuropathic itch
- Psychogenic Pruritus
 Seborrheic dermatitis
 Contact dermatitis
 Anxiety
 Lichen planopilaris
 Lice
 Psoriasis

SCALLP acronym in order to easily recall the most common


causes of scalp itch
Scalp Itch with Skin Lesions
Scalp Itch with Scaling/Erythema Seborrheic Dermatitis (16% of the adult
Scalp itch associated with population)
interfollicular and perifollicular Is one of the most common causes of scalp
scales and/ or erythema can be due itch.
to the following causes: seborrheic Other common symptoms included
dermatitis; scalp psoriasis, contact
sensations of prickling, tightness, pain and
dermatitis; early lichen planopilaris
(LPP);Tinea capitis;dermatomyositis
burning
and xerosis secondary to atopic
dermatitis or aging skin. Contact Dermatitis
Clinically, it may present with itch, erythema,
and scaling. Other common scalp allergens
Psoriasis ( 67-97%) implicated in scalp contact dermatitis include
Possible mechanisms that explain fragnances and preservatives that are typical
pruritus in scalp psoriasis are ingredients of shampoos, conditioners and hair
hyperinnervation, neurogenic styling products. It also important to ask about
inflammation, neuropeptide misbalance, the type of brush associated with nickel,
abnormal functioning of the peripheral
rubber, or plastic may be the cause of the
opioid system, cytokine release and
vascular abnormalities
problem
Tinea Capitis Dermatomyositis ( has been linked to
May cause severe pruritus, pruritus in up to 94% of diagnosed
erythema, and scaling; alopecia patients)
may or may not be present. A Other scalp manifestations that may be
prominent inflammatory reaction is present are erythema, atrophy, scales,
typical for kerion lesion and and diffuse non-scarring alopecia
presence of servical node
enlargement suggest diagnosis.
Wood’s light may help to identify
infection by Microsporum audoinii Scalp Itch with Alopecic Patches
and M. canis by the presence of Distinguishing between non-scaring and
green fluorescence. scarring alopecias is an important aspects of
clinical evaluation. Non-scarring alopecias
associated with scalp itch include alopecia
Sensitive Scalp / Atopic Dermatitis areata (complain of mild itching or burning) and
In this condition , the scalp is adrogenetic alopecia (often complain of scalp
prone to experiencing pruritus, and itch and frequently have concomitant
paresthesias including prickling, seborrheic dermatitis). The most common types
burning, and tingling when of scarring alopecia associated with itch are
exposed to physical, psychological LPP, frontal fibrosing alopecia, discoid lupus
or hormonal factors. An linked to a erythematosus, and central cicatrical
specific immune or allergic centrifugal alopecia.
mechanism.
Urticarial Lesions
Usually doesn’t present with the
classic findings of erythema and
edema, because of the scalp’s skin
structure. Rather, patients
complain of irritation, pruritus, Infestations
stinging, or burning of the scalp. Some patients with scalp itch may
Contact urticarial occurs with present with infestations, with the
interactions with an most common being lice and
irritating/allergic substance. scabies.
Scabies usually spares the scalp in
Other Skin Lesions adults, but may be present in this
Other more specific lesions that location in children and
may be diagnosed clinically or with immunocompromised patient.
a biopsy are: seborrheic keratosis,
keloid scars, burns, eosinophilic,
polymorphic, and pruritic eruption
associated wiyh radiotherapy
(EPPER) and rarely skin tumors.
Keloid scars and burn lesions
cause peripheral neuropathic itch.
Scalp itch without Skin lesions

Neuropathic Itch Psychogenic Pruritus


Is caused by an abnormality in The most difficult part of the
the afferent pathway of the assessment of pruritus of the
nervous system. It can be central
scalp is when a dermatologist
doesn’t find any dermatological,
or peripheral. Neurological systemic, or neurological cause
causes of pruritus should be of such complaint. The patient
suspected if a patient has with psychogenic pruritus
sensory symptoms like normally presents with a
paresthesia, hypoesthesia, and healthy scalp or with secondary
hyperalgesia in the same area lesions such as scratch marks
and there is no dermatological or and excoriations, without a
systemic cause primary lesion
CONCLUSION

Itch is a common complaint in the dermatological


setting. A dermatologist must use an algorithmic
approach to investigate the possible cause of
scalp pruritus. Also, it’s important to think first
about the most common causes and then rule out
other, less common etiologies. The acronym
SCALLP and the five steps for scalp evaluation are
useful tools to keep in mind for an assertive
approach in these patients