Trichodynia Silenced Effectively with Propranolol

Sir,

Trichodynia, or “hair pain,” is defined as pain while touching the hair. Etiopathogenesis is probably multifactorial. What stands out above all is the increased expression of substance P, psychiatric disorders, and perifollicular inflammation. Some authors also take into account the nutritional deficiencies (iron, Vitamin B12, ferritin, zinc, Vitamin D, and Vitamin E).[1]

We were consulted by a 76-year-old Caucasian female presented with the complaint of hair loss of 5-year duration. She complained of pain in hair and scalp while combing the hair, when touching hair, and when wearing a hat. Symptoms were accompanied by burning of the scalp and feeling hot. There was no history usage of any application on the scalp, except for coconut hair oil, which she used for long time. She has been taking oral trazodone for 6 years because of depression. In treatment she used oral hydroxyzinum, where symptoms subsided for 2 h. She also used dexamethasone (intramuscular), bringing a 4-h improvement.

Skin examination was normal except for mild erythema and slight hair thinning [Figure 1]. The scalp was highly tender to touch. However, there were no associated cutaneous lesions. Her baseline investigations including complete blood count, blood sugar random, urinalysis, Serum Vitamin B12 levels, and serum ferritin were normal. Patch tests made a month ago were negative.

Figure 1.

Thinning hair on the scalp in a patient with trichodynia

At the beginning was used hydroxyzinum 25 mg/evening and bilastine 20 mg in the morning. No satisfactory results were found.

In our experience in psychodermatosis, we use propranolol and sertraline. We used propranolol 10 mg 1 tablet daily. Receiving improvement and relief of symptoms, it happened after 5 days. We used the medicine for 2 months. The lesions were recurrence 6 months after drug discontinuation, after a major depressive attack.

Trichodynia (cutaneous dysesthesia syndrome) is a painful sensation at the scalp some. It is defined as discomfort, pain, or paresthesia of the scalp. The cause of trichodynia is not known, but it is suggested to be of multifactorial origin.[1] It is commonly believed that trichodynia correlates with emotional upset. Trichodynia is almost exclusive of patients with active telogen effluvium, was described in the alopecia areata (14% of cases), folliculitis decalvans, or frontal fibrosing alopecia.[2]

Clinically, trichodynia may reveal diffuse erythema. Dermoscopy often gives an image of widened blood vessels. The reasons still are not entirely clear but may be related to the release of the substance P, as a potent vasodilator and may explain observed here vasodilation sometimes.[3]

The skin biopsy in our patient showed vasodilatation with nonspecific lesions.

Authors from Canada proved that beta-blocker (propranolol) given within hours of a psychologically traumatic event reduces physiologic responses during subsequent mental imagery of the event.[4]

Although evaluating expression the β₂-adrenergic in vascular lesions admittedly that the positivity of the receptors does not necessarily correlate with therapeutic management, we used in our patient with successfully 10 mg propranolol.

Propranolol hydrochloride is a nonselective beta-adrenergic blocking agent and is commonly prescribed for cardiovascular diseases.[5]

There is no consistently effective treatment of trichodynia. In our opinion, oral propranolol may be a therapeutic option worth trying in certain patients.

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