Scalp pain & shedding post PRP - how can I treat this?

Question

I had 1 session of PRP in April this year. Nothing was wrong with my hair, I was just hoping to thicken it up. 4 weeks later I started having intense itching and tingling followed by hair fall and burning sensation on the scalp. This has been going on for 3 months. My scalp looks normal other than getting red and hot when it starts to burn. The symptoms come and go and I believe it is burning scalp syndrome with Telegen effluvium. Steroid creams did not help. How can I treat this?

Homeira Izadi, MD · Answer

Usually if there is burning scalp with hair loss, we need to investigate and first rule out more serious causes such as Lichen planopilaris /central cetrifugal cicatricial alopecia, discoid lupus erythematous. You need a comprehensive evaluation and skin biopsy. Treatment depends on the underlying cause of these symptoms.

Anna Chacon, MD, FAAD · Answer

Hello,

I'm sorry to hear about the discomfort and hair shedding you've been experiencing following your PRP treatment. Based on your description, it seems you might be dealing with a condition known as "burning scalp syndrome" and possibly telogen effluvium, which can be triggered by stress, hormonal changes, or other factors, including hair treatments.

Here are a few steps you can take to manage and potentially alleviate your symptoms:

Consult a Dermatologist: Since steroid creams did not help, it is crucial to have a thorough evaluation by a dermatologist. They can provide a more accurate diagnosis and suggest appropriate treatments.

Gentle Hair Care: Use mild, sulfate-free shampoos and conditioners. Avoid harsh hair treatments, heat styling, and tight hairstyles that can further irritate your scalp.

Topical Treatments: Your dermatologist might recommend other topical treatments such as minoxidil, which can help with hair regrowth, or other medications to soothe your scalp.

Oral Medications: In some cases, oral medications such as antihistamines or anti-inflammatory drugs may be prescribed to reduce itching and inflammation.

Stress Management: Stress can exacerbate scalp conditions, so incorporating stress-reducing techniques such as meditation, yoga, or regular exercise might be beneficial.

Supplements: Ensuring a balanced diet and possibly incorporating supplements like biotin, zinc, and iron can support hair health. However, consult with your healthcare provider before starting any new supplements.

Patch Testing: If there's a possibility of an allergic reaction to the PRP or other products used, a patch test can help identify specific allergens.

Remember, it is essential to follow up with a healthcare professional who can tailor the treatment to your specific needs and monitor your progress.

Flaviu Sebastian Deme, MD · Answer

Based on what you've described, burning scalp syndrome (also called scalp dysesthesia) with a secondary telogen effluvium is certainly one possibility, but it would be important not to assume the PRP is necessarily the cause without a thorough assessment.
A few points stand out:
Your hair was healthy before the PRP.Symptoms started about 4 weeks later, with itching, tingling, burning, followed by increased shedding.The scalp appears largely normal between episodes, although it becomes red and hot during flares.Topical steroid creams have not helped.Could PRP have caused this?
There is no well-established evidence that PRP itself causes chronic burning scalp syndrome. However, there are a few possibilities:
Coincidental onset of another scalp condition.A temporary inflammatory response triggered by the injections.Irritation of superficial sensory nerves from the injection process (rare).A telogen effluvium triggered by the procedure or by the physiological stress surrounding it.
It's also possible that the burning symptoms and the hair shedding are related but not caused by the same process.
Other conditions that should be considered
A dermatologist or hair specialist would usually want to exclude:
Telogen effluviumEarly androgenetic alopecia that has become noticeable after sheddingSeborrhoeic dermatitisAllergic or irritant contact dermatitisScalp psoriasisFolliculitisNeuropathic scalp pain (scalp dysesthesia)Less commonly, autoimmune or inflammatory hair disorders such as lichen planopilaris, especially if there is persistent burning or tenderness.What investigations might be helpful?
If symptoms have persisted for three months, I would consider:
Careful scalp examination with trichoscopy (dermoscopy)Hair pull testBlood tests if appropriate, including:Full blood countFerritin/iron studiesThyroid functionVitamin D (if clinically indicated)Vitamin B12 and folate (if risk factors are present)Occasionally a scalp biopsy, but only if the examination raises concern for an inflammatory scarring disorder.If this is burning scalp syndrome (scalp dysesthesia):
Identify and treat any underlying scalp condition.If no inflammation is present, topical steroids often don't help&mdash;which matches your experience.Some patients improve with medications that target nerve-related pain, such as gabapentin, pregabalin, or low-dose amitriptyline, but these require assessment and prescription by a doctor.Stress reduction and good sleep can also be helpful, as symptoms sometimes worsen during periods of psychological or physical stress.
If the shedding is telogen effluvium:
The shedding usually settles once the trigger resolves.Hair often begins to recover over several months, although complete recovery may take 6–12 months.Treatment focuses on correcting any underlying trigger rather than trying to stop the shedding immediately.When should you seek prompt review?
I would recommend seeing a dermatologist or hair specialist sooner rather than later if you notice:
Increasing scalp painPatches of hair loss rather than diffuse sheddingScaling, pustules or crustingLoss of follicle openings or shiny skinProgressive thinning despite improvement in sheddingMy overall impression
Your symptoms could represent scalp dysesthesia with a coincidental or triggered telogen effluvium, but because you've had persistent burning for three months, I'd be cautious about making that diagnosis without an in-person examination. The fact that steroids haven't helped and your scalp looks normal between episodes does make a neuropathic cause more plausible, but it's important to exclude inflammatory scalp diseases before settling on that diagnosis.
The good news is that most cases of telogen effluvium recover, and if this is scalp dysesthesia, there are treatments beyond steroid creams that a dermatologist can discuss once the diagnosis is confirmed.I hope this is helpful.

Scalp pain & shedding post PRP - how can I treat this?

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