Identifying chronic scalp itch and irritation

Of all the persistent maladies which beset the human body, one of the most challenging and confounding for practitioners is chronic scalp irritation or itching where no other obvious condition (1) is found. 

The causes of chronic scalp irritation or itching (CSII) are widely multi-factorial, and in some instances polygenic from an atopic family history. Some of the many reasons for CSII:

• Nutritionally poor diet or one accented to refined, calorie-dense foods – fast food or foods high in sugar and trans-fats. Vegetables and some fruits which contain anti-inflammatory phyto-chemicals are especially important to skin health.
• Liver or kidney disease, including nutrient, hormonal or metabolic disturbance (2) which may cause sluggish liver detoxification pathways resulting in poor ‘waste’ removal of toxins from the body.
• Hypothyroidism, iron or zinc deficiency will cause the skin to be dry, scaling and itchy.
• Gilbert’s Syndrome where bilirubin levels are significantly elevated above 20-30 umol/L (3).
• Severe or ongoing intense stress where adrenal hormones (4) are continually elevated with a resultant hyper-sensitivity of the skin.
• Elevated Insulin, toxic heavy metals – including Copper excess, and other substances inflammatory to the body (5).
• Neuropathic/neurogenic causes – often from damaged ascending pain pathways rather than the skin itself is a known cause of chronic skin itching and irritation. ‘Neuropathic Itch’ (NI) may be due to brain injury (6), cerebro-atherosclerosis (7) or autoimmune scarring alopecia conditions (8).
• Rare forms of Lymphoma (termed: grey zone lymphoma) which attack the immune system. Intense itching of the skin for months may precede diagnosis.
• Deficiency of immunologically calming nutrients such as Zinc or Vitamin D, or Cortisol or Progesterone insufficiency (9).
• The adverse effects on the skin of long-term smoking, alcohol or illicit drug abuse (10).
• Senescent ageing of the skin where underlying cells of the dermis progressively dry, poorly differentiate or divide, and become microscopically fibrosed as scar tissue. This process is often accelerated in those who spend long periods exposing their skin to the sun.
• Scalp receptor sensitivity to androgens (11) – particularly in females.
• Gut dysbiosis can often reflect as irritated, sensitive skin. Probiotics are now available which aid in reducing atopic skin conditions such as eczema.
• Scalp microbiome imbalance of dominant commensal organisms (12)
• Dehydration: insufficient intake of free-fluids (ie: water) and excessively consuming beverages (such as coffee) which can lead to skin dehydration.

Treatment approach should be investigative to assess for any underlying factors, and the problem itself treated symptomatically and appropriately for each patient.

 

Usual medical treatment options:

• Corticosteroids – generally as a topical therapy to aid in minimizing the itching and irritation. Topical cortisone is essentially a temporary treatment which has what’s known as a ‘rebound effect’- meaning that if used too frequently or for too long and then ceased – the condition being treated resumes more intensely than it was before.
• Immuno-modulating drugs of various names and application. 
• Immunosuppressant or anti-androgen drugs.

ALL these prescription medications carry potential adverse effects, so the patient should be regularly monitored by their prescribing doctor.

 

Wholistic treatment approach and treatment:

• Commence with the readily altered changes such as diet, lifestyle and hair products.
  • Scalp irritation and itching is a common symptom that your hair is not being cleansed (ie: shampooed) enough. Two-three times per week is adequate in the cooler months, but cleansing the scalp daily in hot, humid months – particularly if physically active – is most desirable.
  • Alternately if you feel the onset of scalp irritation and itching 30-90 minutes after shampooing, chances are it’s the product itself which is the cause. General rule: a highly perfumed product tends to be more reactive and a potential skin irritant than a non-perfumed one.
  • For those experiencing scalp irritation, mild folliculitis, dry or flaking scalp: rinse your hair with a diluted white vinegar solution at least once per week.  Leave on for at least 10 minutes or you may towel dry your hair (but don’t rinse out) and leave overnight.  Vinegar is an anti-microbial and pH alkaline. Our scalp is more alkaline in pH, but most modern shampoos and conditioners tend to reduce scalp alkalinity or induce a more acidic scalp pH (Chan: 2018).   This simple rinse will in time have your scalp feeling quite vibrant, less irritated – which means improved scalp and follicle health. 50-100 mls in a litre of tepid (not hot) water; water should preferably be fully cooled pre-boiled water or filtered water ideally chlorine and fluorine (fluoride) free.

• There are a multitude of commercially available treatment shampoos and sprays which may give symptomatic relief but is often a process of finding what’s helpful for you. Ketoconazole or Selenium-based shampoos may reduce androgen sensitivity when used regularly but can be too scalp-drying if used more than 2-3 times per week.
• Low level laser light (LLLT) is often very effective due to its anti-inflammatory and increased blood perfusion influences on the skin.
• Aromatherapy, Day Spa treatments or even Acupuncture may assist with temporary, relief of symptoms.

Copyright Anthony Pearce November 2022 (revised January 2023)

 

1. Psoriasis, Eczema or Seborrhoeic dermatitis etc.
2. Iron deficiency, hypothyroidism or oestrogen overload are some causes of poor liver detoxification. Alcohol, nicotine, caffeine, illicit drugs, synthetic hormones from contraceptives and HRT are the main substances which potentially overload liver detoxification capacity. Chronic kidney failure is known to cause a grey skin pallor which is sometimes intensely itchy.
3. Gilbert’s syndrome is an inherited genetic disorder which affects the liver’s ability to metabolise the ‘yellow-brown’ pigment of bile (bilirubin). Patients are usually asymptomatic, but condition can cause a yellowing of the whites of the eyes, and a jaundiced skin which is chronically itchy.
4. Adrenaline, Cortisol, and weaker male hormones which can up-convert to Testosterone and Dihydrotestosterone. Elevated adrenal hormones will have a significant disruptive effect on thyroid hormone, progesterone receptors, and Insulin levels.
5. Iron infusions resulting in rapid, significant elevation of tissue iron levels can be a cause of skin irritation. Iron is highly oxidative with a very reactive potential which may result in physiological tissue or organ damage to the body from the high amounts administered.
6. Stroke or spinal cord injuries.
7. A hardening and plaquing of the arteries in the brain.
8. Folliculitis decalvans, Pseudopelade, Lichen planus or Sjogren’s syndrome. Often the onset of these conditions is preceded by months or years of scalp irritation or itching.
9. Progesterone (P4) sex hormone insufficiency in females. Oestrogen deficiency is also known to cause prematurely aged and dry skin, sometimes resulting in itching, irritated dry skin (termed Xeroderma).
10. Nicotine (and the many other chemicals found in commercial cigarettes) essentially destroys Vitamins C, B-group, skin collagen and elastin fibres. Nicotine diminishes production of the so-called ‘youth’ hormone DHEA. Heroin and other opioids are known to cause chronically itching skin.
11. Androgens is the collective term of the various male hormones. Dihydrotestosterone is the most potent of the male hormones, and its activity in the scalp is often a complaint for its tactile skin effects: ‘burning’, itching, ‘crawling’ skin sensations etc.
12. Our scalp microbiome is comprised of certain bacteria and yeast (fungal) species which – when in harmonious balance with each other – are believed to be protective of skin integrity. For further information: #microbiomehealth posted by Ms. Jane Davies WTS @ The Hair Physio.