Itching and other troubles: why the scalp itches and what to do about it

Main types of scalp

• Normal, with the sebaceous glands producing only the required amount of sebum to maintain softness and elasticity.
• Dry, with scanty presence of this fat and insufficient supply of nutritional components. The skin dries out and the head itches.
• Flaky dandruff with the appearance of dandruff, scalp burning, discomfort, the patient complains of itching regardless of the type, hormonal imbalance appears.
• Oily, characterized by excess sebum production, tangled and greasy hair.

The structure of the skin includes several layers:

• The deeper ones produce new cells to replace the dead ones on the surface of the epidermis.
• They exfoliate and are removed from the top layer, gradually renewing the scalp.
• Here are hair follicles, sebaceous and sweat glands, sebum, nerve endings, and cells responsible for immune defense.
• They provide metabolic functions, tactile sensations, and regulate skin temperature.

Any failure in these functions can lead to disruption of processes and the appearance of problems when the scalp itches.

Diagnostics

Anamnesis

• Localization : focal or generalized.
• Onset : acute onset is the least characteristic of systemic diseases.
• Duration.
• Nature/character : severe, constant itching, worsening in the evening - scabies;
• “burning” itching – perpetiform dermatitis;
• “tingling” – polycythemia.

Physical examination

• Careful examination of the skin: primary lesions;
• excoriation of the skin in various areas (pediculosis, scabies);
• inflammatory papules on the legs with a small vesicle in the center (flea bites);
• “butterfly” sign in the upper central part of the back (hepatobiliary pathology);
• uremic chills.

Laboratory research

Complete blood count with leukoformula, urea, creatinine, liver tests (markers of cholestasis - alkaline phosphatase, gamma-glutamyl transpeptidase (GGT), determination of bilirubin), thyroxine (T-4) and thyroid-stimulating hormone (TSH), blood glucose.

Scalp problems

The most common complaints include itching, dandruff, dryness and flaking. The causes of these symptoms can be different:

• unfavorable influences of the external environment;
• sun activity;
• chlorinated water;
• blow drying;
• frequent showers;
• incorrectly selected shampoo;
• varnishes, masks and other hair care products;
• low humidity levels;
• allergy;
• hormonal imbalance;
• genetic predisposition.

Also, dryness and itching, flaking of the skin can cause atopic dermatitis and other skin diseases.

Application experience

Under our supervision there were 75 patients aged from 18 to 76 years (34 men and 41 women) with diagnoses of “atopic dermatitis”, “allergic dermatitis”, “chronic eczema in the acute stage”, “lichen planus”, “toxidermia” ( Fig. 2).

Rice. 2. Distribution of patients by nosology

All patients received topical and systemic therapy, including the antihistamine Cetrin (cetirizine) at a dose of 10 mg once a day at night. The duration of therapy is from 14 to 21 days, depending on the diagnosis. Patients assessed the effectiveness of itching relief using a point system: 0 points - no itching, 1 point - mild itching (present, but not bothersome), 2 points - moderate (bothering, but does not interfere with daily activity and/or sleep), 3 points - severe /intense itching (disturbs and interferes with daily activity and/or sleep).

The maximum reduction in itching intensity was observed within 3 hours of taking the drug in the first five days (Fig. 3).

Rice. 3. Average subjective assessment of the intensity of itching after using the drug

Subsequently, a decrease in itching or its absence was noted by the 10th day of therapy, with a simultaneous decrease in the clinical manifestations of the disease (Fig. 4).

Rice. 4. Dynamics of clinical manifestations

The results obtained demonstrate the high effectiveness of Cetrin (cetirizine) in the treatment of chronic and acute dermatoses. Cetrin (cetirizine) has a pronounced antipruritic effect, and also reduces other clinical manifestations of allergic dermatoses (infiltration, erythema). In addition, the drug can also be used for somatic diseases as symptomatic therapy.

Bibliography:

1. Duncan WC, Fenske NA Cutaneous signs of internal disease in the elderly // Geriatrics. 1990. Vol. 45. No. 8. P. 24-30.
2. Masmoudi A., Hajjaji Darouiche M., Ben Salah H. et al. Cutaneous abnormalities in patients with end stage renal failure on chronic hemodialysis. A study of 458 patients // J. Dermatol. Case Rep. 2014. Vol. 8. No. 4. P. 86-94.
3. Abel EA, Farber EM Malignant cutaneous tumors // Scientific American Medicine / eds. E. Rubenstein, D. D. Federman. Section XII. New York: Scientific American, Inc., 1992. P. 1-20.
4. Dangel RB Pruritus and cancer // Oncol. Nurs. Forum. 1986. Vol. 13. No. 1. P. 17-21.
5. Bernhard JD Clinical aspects of pruritus // Dermatology in General Medicine / eds. T.B. Fitzpatrick, A.Z. Eisen, K. Wolff et al. 3rd ed. Chapter 7. New York: McGraw-Hill, 1987. P. 78-90.
6. Smirnova G.I. Antihistamines in the treatment of allergic diseases in children. M., 2004.
7. Gushchin I.S. Cetirizine is a standard H1-antihistamine // Mistetstvo Likuvannya. 2009. No. 5. P. 60-70.
8. Belsito D. Second-generation antihistamines for the treatment of chronic idiopathic urticaria // J. Drugs Dermatol. 2010. Vol. 9. No. 5. P. 503-512.
9. Grant J., Riethuisen J., Moulaert B., DeVos C. A double-blind, randomized, single-dose, crossover comparison of levocetirizine with ebastine, fexofenadine, loratadine, mizolastine, and placebo: suppression of histamine-induced wheal-and -flare response during 24 hours in healthy male subjects // Ann. Allergy Asthma Immunol. 2002. Vol. 88. No. 2. P. 190-197.
10. Kavosh E., Khan D. Second-generation H1-antihistamines in chronic urticaria: an evidence-based review // Am. J. Clin. Dermatol. 2011. Vol. 12. No. 6. P. 361-376.
11. Volosovets A.P., Krivopustov S.P., Pavlik E.V. The role of allergic inflammation in everyday medical practice. Optimization of antiallergic therapy // Medical literature (Kyiv). 2010. No. 1. P. 70-75.
12. Nekrasova E.E., Ponomareva A.V., Fedoskova T.G. Rational pharmacotherapy of chronic urticaria // Russian Allergological Journal. 2013. No. 6. P. 69-74.

Types of skin itching

The condition when the back of the head or the entire skin itches is a protective reaction to remove the irritating factor. There are different types of itching:

• Dermatological, characteristic of atopic dermatitis, scabies, lice, psoriasis.
• Neurological, arising from lesions of the nervous system.
• Systemic, observed in various pathologies of internal organs.
• Psychogenic, appearing under stress and psycho-emotional tension.
• Multifactorial, in the case of simultaneously different causes of origin.
• Idiopathic, with an unclear etiology.
• Other.

Other mental and nervous disorders

It is worth noting that these unpleasant sensations in the intimate area also appear with other types of neurosis.

Here is a case described in psychotherapeutic practice. A young woman aged 22 went to a psychiatric hospital. Because of this, their sexual and marital life is destroyed, the couple is on the verge of divorce.

During the survey, it was found that the girl got married at the insistence of relatives at the age of 19. And her husband is 18 years older than her. She developed normally, and at the time of coming to the center she was physically healthy, including gynecologically.

Conclusion: hysterical psychopathy , a symptom of hysterical genitalgia. This symptom developed due to the girl’s negative attitude towards her husband and sex life in general. Pain and burning in the vagina in this case act as an unconscious pathological adaptation mechanism for avoiding sexual intimacy with the husband. The symptom was eliminated with the help of hypnosis, but the dislike of sexual relations remained.

Thus, in this situation, a burning sensation in the intimate area became a manifestation of exclusively mental disorders, despite physical health.

Vegetative-vascular dystonia can also be accompanied by sensations of heat and itching in the body. The reason for this is an imbalance in the functioning of the nervous system. This disorder leads to changes in cardiac activity, which is why the condition is often accompanied by a burning sensation in the chest. It is accompanied by other symptoms such as arrhythmia, shortness of breath, heart pain, pressure surges, dizziness and loss of consciousness.

What to do if you're dry

Choose milder herbal shampoos enriched with plant oils and extracts. They will help restore lost balance and remove increased sensitivity, redness and irritation.

Use argan and olive oil, which contains unsaturated fatty acids and vitamin E (tocopherol), which transform hair into elastic, elastic and silky. They contain linoleic, oleic, palmitic, stearic, vanillic acid, as well as fungicides, tyrosol, and sterols. This composition moisturizes the scalp and strengthens brittle hair.

Take a not too hot shower, wash with slightly warm water. Higher temperatures help remove fat, causing irritation.

Care Tips

• Prevention of scratching: short-filed nails, lightly rubbing itchy areas.
• After washing, dry your skin carefully using wet movements, use a soft towel or a hair dryer on a cold setting.
• Avoid long hot baths. Try a bath with sodium bicarbonate (baking soda) or medicated oils.
• Use loose clothing and loose bedding/blankets.
• Avoid overheating and sweating, especially during night sleep.
• Increase the humidity in the bedroom so that your skin loses less moisture.
• Wear cotton gloves at night to prevent scratching.
• Avoid damaging the skin with alcohol-containing rubbing, woolen clothing, and excessive hygiene procedures.
• Cleanse your skin gently using moisturizers.
• Use cooling, soft compresses.
• You can use an anesthetic mixture: aftershave cream with menthol 50 ml, Diphenhydramine 1% 3–5 ml, Lidocaine 2% 1–2 ml, Novocaine 0.5% 5–10 ml. Mix and serve chilled.
• Use relaxation and positive visualization techniques.

Pathologies that cause acute itching of the scalp

• Dandruff can be large in oily skin and small in dry skin. It appears as a result of stress, poor nutrition, hormonal imbalance, and the influence of a warm and humid climate.
• Seborrheic eczema is characterized by not only itching, but also rashes, redness and inflammation of the skin, often leading to the appearance of blisters. The rash can also affect the neck and face.
• Fungal infections are difficult to treat and cause itching, redness, blisters, and peeling. Over time, fungal spores penetrate deeper layers and cause severe infection and intoxication. They easily infect other people and are transmitted through contact and household contact.
• Seborrheic dermatitis is characterized by inflammation and affects areas rich in sebaceous glands. It is caused by fungi of the genus Malassezia, the same as dandruff, and is characterized by flaking and varying degrees of damage to the skin and hair.
• Infestation with lice, fleas, ticks and other parasites turns hair into a breeding ground for disease. They become covered with nits, which are difficult to comb out even with a special comb. In this case, total treatment with anti-pediculosis drugs, which are sold in pharmacies in the form of sprays and solutions, is required.
• Allergic reactions can occur even to hair care and styling products that have been used for more than one year. The cause of the allergy can be found out with a test from a dermatologist.
• Chemical and mechanical irritation with acute itching is also caused by hair dye, wearing tight headwear, and the use of care products with aggressive components included in the composition.
• Psoriasis manifests itself as small flaking of the scalp, redness, formation of plaques and thick scabs. It forms both single spots and affects large damaged areas. The patient feels tightness of the skin, itching, and it begins to peel off severely.

Itching of the scalp Constant burning of the scalp, tingling, desire to scratch - painful itching. Why does it arise? The reasons may be the following: an allergic reaction or the development of a dermatological or trichological disease.

Senestopathies

Burning, itchy feelings provoked by mental disorders are classified as simple thermal senestopathies.

Senestopathies are a variety of unpleasant, intrusive and exhausting impressions that are concentrated on the surface or inside the body. This concept was first learned about in 1907 thanks to the scientists P. Camus and Dupre.

The peculiarity of this condition from true burning and itching is the rich and elaborate way of describing them. For example, “there is a fire in the head”, “the chest is on fire”. The localization is characterized by an unusual presentation: “itching in the stomach area”, “a vessel in the abdomen is pulsating”.

Such episodes can be isolated, constant or paroxysmal. Sometimes they are so intrusive that they literally drive the patient crazy.

Their characteristic feature is tactile hallucinations. They often manifest themselves in terms of itching and tingling. A person claims that bugs or mites are crawling under his skin. In some cases, he even sees them, or it seems to him that crumbs or sand are stuck to his body.

Such hallucinations provoke obsessive actions. The patient persistently visits doctors or tries to get rid of intrusive parasites on his own: he constantly washes himself and disinfects his body.

Mental disorders that lead to similar senestopathies:

• hypochondria;
• neuroses and depression;
• psychoses and psychopathy;
• oneiroid;
• paranoia;
• affective and delusional disorders, etc.

Diet

Diet for skin diseases

• Efficacy: therapeutic effect after a month
• Time frame: three months or more
• Cost of products: 1400-1500 rubles per week

Diet for dermatitis

• Efficacy: Therapeutic effect after 3 weeks
• Timing: Constantly
• Cost of products: 1300-1390 rubles per week

Diet for psoriasis

• Efficacy: healing effect
• Timing: constantly
• Cost of products: 980-1150 rubles per week

Diet for facial demodicosis

• Efficacy: therapeutic effect after 30 days
• Timing: during exacerbation/permanently
• Cost of products: 1500-1600 rubles per week

Considering that any dermatological disease has an allergic component, the diet should not contain products with high sensitizing activity, artificial food additives, as well as products containing histamine and promoting its release. These products include: strawberries, cocoa, chocolate, coffee, orange juice, tomatoes, cow's milk, hazelnuts, all cheeses, smoked meats, herring, tuna.

Products with weak allergenic activity: beef, lamb, turnips, zucchini, chicken, pumpkin, squash, apples (green), fermented milk products, green gooseberries, plums, white currants, butter, dried fruits, cucumber, offal, olive oil, pearl barley and rice porridge, green pears.

To extract nitrates from vegetables, they need to be kept cold (especially potatoes to reduce the starch content), cereals must be soaked and boiled in a third of water (drain the water twice after boiling), and when preparing broths, also drain the water several times.

In the diet for atopic, seborrheic dermatitis and demodicosis, easily digestible carbohydrates are limited: sweet pastries, confectionery, jam, sweets, honey, jam, sugar, condensed milk. Excludes sausages, red meat, smoked meats, seafood, marinades and sauces, pickled vegetables, rich broths, mushrooms in any form, spicy dishes, sauces and seasonings (horseradish, vinegar, mustard, mayonnaise, ketchup), canned fish and meat, fatty sour cream. and animal fats, sugary drinks and alcohol. Salt is subject to restrictions. A strict diet must be followed during the period of exacerbation (3-4 weeks).

Pathogenesis

Itching is caused by various types of stimulation of unmyelinated nerve fibers. Free nerve endings (itch receptors) are located in the papillary layer of the dermis. They are excited either directly by a mechanical/chemical stimulus, or by various mediators - histamine , serotonin , neuropeptides , proteases . CNS receptors are involved in the perception of itching.

With itchy dermatoses , the number of mast cells increases significantly, which release various inflammatory mediators ( tryptase , histamine ), prostaglandin D2 , interleukins and leukotrienes, which provoke itching. the main mediator of itching is histamine , the source of which is basophils migrating into tissues to cause inflammation. In pruritic dermatoses, eosinophils release eosinophilic protein, the level of accumulation of which affects the intensity of itching. The pathogenesis of this condition involves substance P, which is released from nerve endings and attracts proinflammatory cells to the inflammatory focus. It also stimulates mast cells. Interleukin-31 also plays a major role in the formation of itching, the level of which in the blood correlates with the severity of dermatitis.

If we consider the occurrence of itching with dry skin, then what is initially important is the overdrying of the skin and loss of moisture. With dry skin, micro-inflammations appear, which leads to skin irritation and itching.

If itching exists for a long time, a focus of excitation is formed in the cerebral cortex and itching becomes a constant reaction of the skin to irritants - external or internal.

Prevention

Prevention of dry skin, itching and skin diseases includes:

• Choosing the right shampoo according to your hair type, especially for sensitive skin.
• Exclusion of alkaline shampoos (pay attention to the pH of the shampoo).
• Infrequent hair washing, since frequent washing reduces the protective properties of the skin and the lipid layer.
• Using shampoos with natural ingredients, allantoin, zinc, ceramides, tar, herbal extracts and panthenol.
• Avoid blow-drying using gels, mousses, varnishes and foams.
• Fighting stress (meditation, yoga, special gymnastics, leisurely walks, moderate sports).
• Strengthening general health, taking care of liver and intestinal health.
• A nutritious and healthy diet, excluding the contraindicated foods mentioned above.
• Rejection of bad habits.