Vera RV, Benítez HAK

Language: Spanish
References: 12
Page: 46-50
PDF size: 176.48 Kb.

ABSTRACT

Trichodynia is a symptom characterized by pain or discomfort of the scalp, commonly associated with inflammatory alopecias, although it may occur in the absence of specific clinical or trichoscopic findings. Its pathophysiology remains unclear and poses diagnostic and therapeutic challenges, particularly in cases of clinicopathological discordance.
We report the case of an 18-year-old female patient presenting with predominant scalp pain localized to the vertex. A prior scalp biopsy suggested early-stage lichen planopilaris. Clinical and trichoscopic evaluations were performed at baseline and during follow-up, and treatment was directed toward the predominant symptom. Clinical examination revealed mild erythema and minimal interfollicular scaling. Trichoscopy showed diffuse erythema, superficial telangiectasias, and preserved follicular openings, without features of active cicatricial alopecia. Treatment with topical clobetasol and venlafaxine 75 mg/day was initiated. After two months, the patient experienced a clinically significant improvement in scalp pain, with resolution of erythema and marked reduction of scaling on follow-up trichoscopy. Transient insomnia was the only reported adverse effect.
Trichodynia may be the predominant manifestation even in the absence of evident clinical or trichoscopic inflammatory activity. In cases of clinicopathological discordance, prioritizing symptom-oriented treatment, including centrally acting agents such as venlafaxine, may be an effective strategy and help avoid unnecessary aggressive immunomodulatory therapies.

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