Abnormal sensations above may be rooted in problems below.
Scalp dysesthesia is a cutaneous syndrome first described in 1998 in 11 women with chronic pruritus, burning, stinging, itching, or pain of the scalp in the absence of "objective findings." Nine of the patients benefited from low-dose antidepressant therapy. The investigators did not determine if underlying cervical spine disease was present.
Brachioradial pruritus and notalgia paresthetica are characterized by localized pruritus caused by spinal cord pathology. Magnetic resonance imaging (MRI) studies show nerve compression in the cervical-thoracic spinal column correlating with the distribution of pruritus. These authors investigated whether scalp dysesthesia was associated with cervical spine disease.
A retrospective chart review at a university dermatology department identified 15 patients with scalp dysesthesia. All were white women aged 38 to 83 years. Two patients had depression; one had anxiety. No primary lesions were found, although three patients had secondary excoriation at the symptomatic scalp areas. Symptoms included burning (7 patients), pruritus (6 patients), or both (2 patients). Two patients had "bugs crawling" sensations. Two had chronic neck pain; one had prior C6-C7 fusion. Symptoms were diffuse in 10 patients, and localized to various scalp regions in 5. One patient also had "burning" in the right arm. Cervical spine disease was found in 14 patients, confirmed by radiographs, MRI, or computed tomography. The most common radiographic abnormality was degenerative disk disease (DDD), present in 11 patients: at C5-C6 in 10 patients, C5-C7 in 5 patients, and multilevel disease in 6 patients. Other findings included anterolisthesis, osteophytes, lordosis, kyphosis, and nerve root impingement.
Gabapentin (topical or oral) was offered to 14 patients; 4 of the 7 patients with follow-up data had improvement. Three patients reported improvement with topical corticosteroids. Three patients received low-dose antidepressants. Two patients completed neck physical therapy, and 7 had neurology referral, but results were not reported.
CITATION(S):
Thornsberry LA and English JC III. Scalp dysesthesia related to cervical spine disease. JAMA Dermatol 2013 Feb; 149:200.
