Itchy scalp is a common symptom that can have many different causes. For those with multiple sclerosis (MS), itchy scalp may be one of the early symptoms experienced. Understanding the link between MS and itchy scalp can help provide insight into this autoimmune condition.
What is Multiple Sclerosis?
Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system. With MS, the immune system attacks the protective covering (myelin sheath) around the nerves, leading to damage and scarring. This disruption in communication between the brain and body leads to various symptoms. Some of the most common symptoms of MS include fatigue, numbness/tingling, vision problems, mobility issues, bladder dysfunction, cognitive changes, pain, and itchy skin.
MS is a progressive disease, meaning symptoms tend to worsen over time. The progression occurs through relapses (periods when new symptoms appear) and remissions (when symptoms improve or disappear). There are a few main types of MS:
– Relapsing-remitting MS – This is the most common form, with symptoms worsening during relapses and improving during remissions. It can eventually transition into secondary progressive MS.
– Secondary progressive MS – There is a steady worsening of symptoms over time, with or without relapses along the way.
– Primary progressive MS – Steady worsening of symptoms from the beginning, without distinct relapses or remissions.
What Causes Itchy Scalp?
Itchy scalp, also known as pruritus capitis, has many potential underlying causes:
– Dry skin – Lack of moisture allows dead skin cells to build up, triggering itchiness.
– Dandruff – Flaking of the scalp due to fungus (malassezia).
– Psoriasis – An autoimmune condition causing scaly, itchy plaques.
– Eczema – Chronic inflammatory skin condition.
– Allergies – Reaction to hair products or other environmental allergens.
– Lice – Parasitic insects feed on blood, causing irritation.
– Fungal infection – Ringworm on the scalp can causeScaling, redness and itching.
– Skin conditions – Such as seborrheic dermatitis.
– Nerve-related – Neuropathic itch caused by MS lesions affecting nerves.
For those with MS, itchy scalp is often caused by the neurologic effects of the disease rather than issues with the skin itself.
The Link Between MS and Itchy Scalp
Itchy scalp can be an early presenting symptom in people eventually diagnosed with MS. One study found itchy skin, including scalp itchiness, to be the initial symptom in 2-5% of MS patients. It can develop even before more well-known symptoms like fatigue and visual disturbances.
The itchiness associated with MS is referred to as neuropathic pruritus. It occurs when demyelination interferes with signaling between the central nervous system and the nerves supplying the skin. Essentially, the “wiring” between the brain and the scalp is disrupted.
This may cause abnormal sensations leading to chronic itching. Just as MS can cause numbness or tingling, it can also make the nerves overreact and fire repetitively, bombarding the brain with itch signals.
Some causes of neuropathic MS itch also include:
– Cytokine chemical imbalance
– Secondary sensitization effects
– Changes in opioid, cannabinoid and serotonin signaling
Because there are no skin findings like flaking or inflammation, the itch is typically worse at night and caused by contact, heat, or sweating on the scalp. It also fails to respond to regular treatments aimed at the skin. But not all scalp itch in MS patients is neuropathic.
Some research suggests patients with MS-related scalp itch were more likely to have concomitant skin issues like dandruff, seborrheic dermatitis or psoriasis. So skin problems may coincide with and exacerbate MS itching in some cases.
Other Areas of Itchy Skin
While the scalp is a prime target, MS can cause itching sensations across the body. Some other common sites of itchiness linked to MS include:
– Arms and legs – May be symmetrical or one-sided
– Back – Between shoulder blades is a typical spot
– Face – Especially the forehead and cheeks
– Torso – Lower back region prone to itching
– Hands and feet – Palms and soles often affected
The itchiness can be severe, frequent, and frustratingly difficult to control at times. It may flare suddenly with no apparent trigger. Moving or rubbing the skin may provide temporary relief but also makes the urge to scratch even stronger.
Diagnosing the Cause
Itchy scalp on its own does not automatically mean someone has MS. It is a vague symptom with many potential causes. However, unexplained itchy scalp combined with other neurologic symptoms may increase suspicion for MS.
To diagnose MS as the source of scalp itching, a neurologist will gather a full history of symptoms, perform a physical exam, and run certain tests which may include:
– Bloodwork – Checks for indicators of autoimmunity or infection
– MRI – Detects areas of demyelination in the brain/spinal cord
– Spinal tap – Analyzes cerebrospinal fluid for inflammation
– Nerve conductivity tests – Measures how well signals travel along nerves
MS Itch Treatment Approaches
Treating itchy scalp or skin caused by MS presents unique challenges since the source is neuropathic. Typical anti-itch creams, shampoos and home remedies may provide little relief. Some treatment approaches include:
– Corticosteroids – Oral or IV versions help reduce inflammation from MS lesions.
– Antihistamines – Block histamine’s role in itch signals. Sedating types preferred at bedtime.
– Anticonvulsants – Neurontin (gabapentin) can reduce nerve excitability.
– Tricyclic antidepressants – Amitriptyline changes nerve signaling.
– Phototherapy – Ultraviolet light therapy modifies immune activity in the skin.
– Alternative therapies – Massage, cooling agents, capsaicin, cannabis-based products.
Identifying and treating any skin conditions as well can provide added relief when combined with systemic and neuropathic treatments. Lifestyle measures like staying hydrated, wearing loose clothing, keeping cool, and reducing stress may help control itchiness episodes.
Coping With MS Itch
Itchy scalp and skin symptoms not only cause physical discomfort, but can lead to mood disorders and social isolation in those with MS. Having coping strategies and a support network is critical. Some tips include:
– Identify and avoid triggers like heat, sweat, and restrictive clothing.
– Keep the skin moisturized to prevent dryness.
– Use ice packs or cool compresses to help distract from itching.
– Get regular massage and acupuncture treatments.
– Join a support group to share experiences.
– Consider counseling to deal with the emotional toll of chronic symptoms.
– Use meditation, imagery or listening to music to relax the mind and body.
– Keep the nails trimmed short to reduce damage from scratching.
– Try habbit reversal training techniques.
– Communicate any significant changes to your healthcare providers.
The Takeaway
Itchy scalp is not an inevitable part of having MS, but it is a relatively common occurrence. MS should be considered as a possibility when standard treatments do not seem to alleviate an itchy scalp. The itchiness often has a neuropathic origin, directly linked to the demyelination process that occurs in MS.
Though frustrating, itchy scalp can be managed through a combination of medications, lifestyle measures, alternative therapies and coping strategies. Being able to recognize it as a symptom of the disease allows patients to access the appropriate treatments. With a dedicated management plan, MS patients can gain better control over nagging itchy scalp symptoms.