From the Guidelines
Ultraviolet B (UVB) therapy, specifically narrowband (NB)-UVB, plays a significant role in treating scalp dysesthesia associated with psoriasis.
Key Points
- NB-UVB is an attractive treatment option for patients with scalp psoriasis due to its efficacy, cost-effectiveness, and safety profile 1.
- UVB therapy has been shown to be locally immunosuppressive, inhibiting epidermal hyperproliferation and angiogenesis, and inducing apoptosis of T lymphocytes, which may contribute to its therapeutic effects in psoriasis 1.
- NB-UVB has several advantages over PUVA, including a lower long-term photocarcinogenic risk, no need for oral medication or photoprotective eyewear, and safety in pregnancy 1.
- The treatment regimen for NB-UVB typically involves 2-3 visits per week to a phototherapy center, with the option for home phototherapy for maintenance therapy once clearance has been achieved 1.
- Patients should be closely monitored by a dermatologist or trained personnel, with regular evaluations and maintenance of accurate treatment records 1.
- While UVB therapy can be effective for scalp psoriasis, it may not be as effective for very thick lesions or in darker-skinned individuals, in which case PUVA photochemotherapy may be considered 1.
From the Research
Treatment Options for Scalp Dysesthesia
- The treatment options for scalp dysesthesia include high-potency topical or intralesional corticosteroids, capsaicin, and topical anaesthetics, sedative antihistamines, tricyclic antidepressants, transcutaneous electric nerve stimulation, botulinum toxin, and vitamin B12 2
- Low doses of oral pregabalin and a topical compound of amitriptyline, lidocaine, and ketamine have also been found to be beneficial in managing scalp dysesthesia 3
- A programme of simple exercises and stretches has been shown to be an effective treatment for scalp dysesthesia, with benefits including reduced symptoms and no adverse effects 4
- Botulinum toxin may have a role in ameliorating neuropathic pain in scalp dysesthesia by limiting the release of neurotransmitters such as substance P, glutamate, and calcitonin gene-related peptide 5
Diagnostic Methods
- Trichoscopy, reflectance confocal microscopy, and biopsy are helpful for the diagnosis of scalp dysesthesia 2, 6
- A visual analogue scale (VAS) for pruritus can be used to record baseline characteristics and track symptoms over time 4
Pathogenetic Factors
- Dissociation, cervical spine disease, and muscle tension seem to be the most important pathogenetic factors in scalp dysesthesia 2
- Cervical spinal changes, psychiatric disorders, and other environmental and habitual factors may also be associated with scalp dysesthesia 3