From the Guidelines
Itching is a common symptom in patchy hair loss due to discoid lupus erythematosus (DLE), lichen planopilaris (LPP), and psoriasis, significantly impacting the quality of life (QOL) of affected individuals. The pathophysiology of itching in these conditions involves inflammation of the skin and hair follicles, with immune cells attacking these structures, leading to the release of pruritogenic mediators. In DLE, patients often experience moderate to severe itching along with redness, scaling, and scarring in the affected areas of the scalp. For LPP, itching is frequently an early symptom, accompanied by burning sensations and tenderness before visible hair loss develops. In scalp psoriasis, itching can be quite intense and is associated with well-demarcated red plaques covered with silvery-white scales, as described in the guidelines of care for the management of psoriasis and psoriatic arthritis 1.
The treatment for itching in these conditions typically involves topical corticosteroids, such as clobetasol propionate 0.05% solution or foam applied twice daily for 2-4 weeks, followed by maintenance therapy. For more severe cases, intralesional steroid injections (triamcinolone acetonide 5-10 mg/ml) may be necessary. Anti-inflammatory shampoos containing ketoconazole 2% or salicylic acid can also help reduce scaling and itching when used 2-3 times weekly. It is essential to address the itching symptomatically to improve the QOL of patients with DLE, LPP, and psoriasis, as the chronic inflammation and skin manifestations can significantly impact their daily lives, as noted in the study published in the Journal of the American Academy of Dermatology 1.
Key considerations in managing itching in patchy hair loss due to DLE, LPP, and psoriasis include:
- Topical corticosteroids as first-line treatment
- Intralesional steroid injections for more severe cases
- Anti-inflammatory shampoos to reduce scaling and itching
- Maintenance therapy to prevent flare-ups and improve QOL
- Early recognition and treatment of itching to prevent long-term sequelae and improve patient outcomes, as emphasized in the guidelines for the management of psoriasis and psoriatic arthritis 1.
From the Research
Itching in Patchy Hair Loss
Itching is a common symptom in patchy hair loss due to various conditions, including:
- Discoid Lupus Erythematosus (DLE)
- Lichen Planopilaris (LPP)
- Psoriasis
Causes of Itching in Patchy Hair Loss
The exact cause of itching in patchy hair loss due to DLE, LPP, and Psoriasis is not fully understood. However, studies suggest that:
- In LPP, itching may be associated with inflammation and scarring of the hair follicles 2
- In DLE, itching may be related to the autoimmune response and inflammation of the skin 3
- In Psoriasis, itching may be caused by the abnormal immune response and inflammation of the skin, leading to scaly and erythematous patches 4
Clinical Features of Itching in Patchy Hair Loss
The clinical features of itching in patchy hair loss due to DLE, LPP, and Psoriasis may include:
- Pruritus (itching) of the scalp
- Erythema (redness) and inflammation of the skin
- Patchy hair loss
- Scarring of the hair follicles
- Trichoscopic features, such as broken hairs and follicular plugging 5, 2
Diagnosis and Treatment of Itching in Patchy Hair Loss
Diagnosis of itching in patchy hair loss due to DLE, LPP, and Psoriasis may involve: