Scalp Redness and Burning : What are the common causes?

Scalp Burning and Redness: What are the top 10 causes?

Scalp redness with an accompanying sensation of burning has many causes. Here, I briefly review the top 10 causes of this scenario.

1) Seborrheic dermatitis.

Seborrheic dermatitis (SD) is an inflammatory condition of the scalp that affects about 3-5 % of adults. Males are more commonly affected than females. SD occurs on body sites where the skin is oily such as the scalp, eyebrows, sides of nose, eyelids and chest. Individuals with SD of the scalp develop red, flaky skin that is often itchy. The scales can be yellow, white or grey colored and are often described as being "greasy." This differs from scalp psoriasis where the scales are often silver and powdery (see below). Itching is more common in seborrheic dermatitis than burning but certainly burning can be present.

2) Psoriasis

Psoriasis is complex immune-based disease which can affect not only the skin, but also the nails and joints. Scalp psoriasis occurs in about 50 % of patients with skin psoriasis. Patients have scalp redness, flaking and scaling. Patients may also have bothersome itching and seem have burning. Although the redness and flaking often cause embarrassment, scalp psoriasis does not usually cause hair loss. 

3) Scarring alopecias 

Scarring hair loss condition or the so called "cicatricial alopecias” are a group of hair loss conditions which lead to permanent hair loss. These conditions may frequently be associated with redness of the scalp as well as a variety of symptoms such as scalp itching, scalp burning and/or scalp tenderness. These include conditions with names such as lichen planopilaris, folliculitis decalvans, lupus and several others.

4) Other inflammatory diseases

A wide variety of other inflammatory scalp conditions, including dermatomyositis and rosacea can be associated with scalp redness and burning. A scalp biopsy can help differentiate these entities.

5) "Red Scalp Syndrome"

'Red scalp syndrome" is a condition which occurs in individuals who have persistent scalp redness that is not explainable by any other condition. The condition was first described by Drs Thestrup and Hjorth. Patients with the Red Scalp Syndrome may have itching and burning but typically do not have scaling or flaking.


6) Irritation

Many products that are applied to the scalp or hair can cause irritation. These include many cosmetic products, including gel, mousse, hair spray and hair dyes. Some treatments for hair loss can also be associated with irritation and redness, including minoxidil and other topical products containing irritants such propylene glycol.

7) Allergic contact dermatitis

Shampoos, hair dyes and even some cosmetic products can cause allergic reactions in the scalp. Although some individuals with allergy have itching or burning in the scalp, many do not. In such cases, a rash may be present on the neck, ears or back where the product came into contact with the skin. Patch testing, done by a dermatologist with specific interest and expertise in this area can help determine if allergies are responsible for the scalp burning.


8) Infection

Infections are a possible causes of redness. Bacterial, viral and fungal infections may cause redness in the scalp. Determining the specific cause may come from a careful history and scalp examination and sometimes submission of a swab or piece of scalp tissue to the microbiology laboratory. 

Bacteria, such as staphylococci, may cause infections of the scalp. Bacteria may also cause infection of the hair follicle, which is a condition called " bacterial folliculitis." A variety of viral infections cause scalp redness. Chicken pox and shingles are two such examples. Scalp ringworm or “tinea capitis” refers to infection of the scalp by certain types of fungi. Scalp redness and scaling may be seen in these cases.

9) Alopecia areata

Alopecia areata is an autoimmune condition affecting about 2 % of the population. It is not typically a cause of scalp redness. The scalp in patients with alopecia areata is usually normal in color but may be pink or peach colored in some cases. Burning or itching can barely occur in the patches. Most however, are asymptomatic.


10) Scalp Dysesthesias 

Patients with scalp dysesesthesias typically have scalp symptoms like itching or burning in the absence of redness. In some cases there may be some minor redness. Scalp dysestheias occur for a variety of reasons rather than a single one. Depression, anxiety, spine disease, multiple sclerosis, fibromyalgia can all contribute.

Conclusion

There are many causes of scalp redness with burning type symptoms. Fortunately, the cause of the redness and burning can often be diagnosed from a thorough examination of the scalp along with a full review of the patent’s story. In complex or challenging situations, a scalp biopsy should be performed to confirm the diagnosis.