Nonpathologic essential pruritus of scalp

Posted by mwam0220 @mwam0220, Apr 7 6:12pm

I am a 59-year-old female. I started with one scab on my scalp and itching to the point my hair was breaking off, causing a small bald spot. My PCP initially thought this was fungal and prescribed Ketoconazole shampoo. I used it for three months without improvement, but the itching over my scalp seemed to spread without other scabs, pimples, flaking, areas of redness or anything detectable. I then underwent a punch biopsy, which showed "folliculitus" and "solar elastosis" which is basically sun damage. My doctor then prescribed Clabetasol. Needless to say, I had no improvement. I then went to see a dermatologist who looked through my hair and scalp and said I had a very normal-looking scalp.
He did another biopsy, just scraping this time, and injected another area of my scalp with a steroid to see if I got relief. The biopsy reported back as a seborrheic keratosis, but because of my continued symptoms and lack of any relief from the steroid, he prescribed doxycycline for a month. Back to derm at the end of that treatment, again without relief. Two more biopsies were done, both on areas of my "normal-looking scalp" and both returned again as keratoses (there were no real lesions, however). He had a resident with him at the time of that visit, and she had suggested an antihistamine. I had tried those, but not on a regular basis. They wanted me to use Xyzal for a month, twice a day. I did that and returned to see him one month later without relief of my symptoms. I was then started on Rinvoq 10mg a day. He thought if it was going to work I should start having some relief within a couple of days. I am now at one week, and maybe I'm just not being patient, but still itching as though nothing has changed. He had said if this didn't work, he didn't really know what to tell me other than I have a non-pathologic, essential pruritus. In the meantime, as I have been doing all these trials, my hair continues with severe breakage and bald spots because of my scratching. Sometimes my scalp feels like it's burning, and like I have chills on it at the same time. I have purchased almost every item Amazon has that has the words "scalp relief" in their title, and nothing helps. This has been going on now for almost nine months and I am very frustrated. The areas of itching are confined to almost the entire top of my scalp to about 1-2 inches above my ears. I have no itching on the back part of my scalp and nothing extending down towards my neck. Has anyone experienced anything like this before? I know essential pruritus is not something that unusual, but I'm really concerned about its lack of response to any kind of treatment. I feel like my next step if it doesn't stop will just be to shave my head and wear a wig.

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celia16 | @celia16 | Apr 7 7:03pm

Wow, that sounds very distressing. I have had itching on my body that is similar. I’m diagnosed with psoriasis, but it doesn’t look like that to me.

Have you seen a neurologist? I saw this article….mentions the burning. You could ask your doctor about it. Good luck.

I’m sending the link by PM,

minnesota10 | @minnesota10 | Apr 8 8:57am

Thank you, I have lived with the same thing you are talking about, for years. I would say 40 plus years.
Nothing works.
I have a spot on the back of my head close to the hair line, and I itch all over my head.
I have used tar shampoo you name it.
It hurts, burns like it is on fire.
After I read what you wrote. I question if it is the sun. At different times of the year I can’t be outside much as I will develop sore on my skin and itch. The only cure is staying out of the sun.
You are not alone.
Thank you

bosco702 | @bosco702 | Apr 9 4:31pm

20 years ago I had extensive sun damage of my face and scalp. My dermatologist sent me to UofP in Philadelphia to a MOS surgeon. Most of my treatment was surgery and scraping but in some cases with superficial damage I was prescribed a cream that is extremely effective but cause’s extremely painful burn. The thing is when you go through the treatment your skin is healed. They called it chemo cream.

celia16 | @celia16 | Apr 9 6:26pm

Have you been evaluated for scalp neuropathy? I’ve read about it.

stormpassing | @stormpassing | Apr 10 9:33am

Hi there, I'm sorry about what you are going through. I have gone through something similar for the last number of years. I would suggest researching scalp dysesthesia. I haven't found anything that consistently helps but am careful with what product I use on my scalp. Sometimes I think it helps and sometimes I don't. I tend to think that for me chronic telogen effluvium is associated with it. The condition is essentially hypersensitive nerve endings in the scalp. Donovan Hair Clinic online has some good articles on it as well as some other websites. I'm surprised that your dermatologist didn't mention this condition to you as it is characterized by abnormal sensations of the scalp (itching, burning, crawling, etc...) with no real scalp pathological conditions. I don't wish to go on gabapentin, pregabalin or amitriptyline which can sometimes help but that is me. I try lots of natural supplements and have currently added N-acetyl cysteine and R-ALA to see if it may make a difference. Good luck!

mwam0220 | @mwam0220 | Apr 10 9:47am

In reply to @minnesota10 "Thank you, I have lived with the same thing you are talking about, for years. I..." + (show)

The thing about the sun damage is that he said if he biopsied numerous people in my age group, probably 75% of them would have the same thing. He said he was sure he had it as well, but it's not usually symptomatic, and that those people wouldn't even know they have it. I found it strange that with the multiple biopsies I had, only one showed the elastosis. I feel like maybe I haven't had the correct area biopsied yet because there has to be an answer. It's so hard to tell, though, because as I had mentioned, he said my scalp was very normal-looking.

Thanks for responding. If I find something that's helpful, I'll let you know.

mwam0220 | @mwam0220 | Apr 10 9:52am

In reply to @bosco702 "20 years ago I had extensive sun damage of my face and scalp. My dermatologist sent..." + (show)

Was that Efudex? I have heard of that for skin damage/cancer. I think I could tolerate the painful burn of the cream if it healed my scalp better than I can tolerate this itching. Did you have lesions that were being scraped or just different areas of your scalp?

Thanks for your response.

mwam0220 | @mwam0220 | Apr 10 9:58am

In reply to @stormpassing "Hi there, I'm sorry about what you are going through. I have gone through something similar..." + (show)

Honestly, I think I would try anything at this point. How have you lived with this for the last number of years? Mine has been going on for nine months, and I'm losing my mind. Is it constant for you, or intermittent? I don't think I'm having hair loss because of whatever's going on; I think it's more from the trauma of scratching. It's just breaking off, which has made it super thin in certain areas.

I will take a look at the Donovan Hair Clinic to read articles. Thank you for that information and thanks for your response.

stormpassing | @stormpassing | Apr 10 3:36pm

Mine seems to be intermittent. Has anyone mentioned trying oral medication like pregabalin, gabapentin or amitriptyline? Also, I know that there are some topical meds that can be compounded that can include these agents as well as a topical anesthetic. Your itching sounds more severe than mine.....mine is more burning and discomfort. Sending you a lot of compassion.

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