People with multiple sclerosis (MS) often confront the question “Is this symptom I am having caused by my MS?”. It’s an important question because people with MS can get the same illnesses anyone else can get-like a cold, a UTI, a rash, or even a stroke. Making the association with MS is important because having more symptoms that mimic increased disease activity might result in therapeutic changes for MS that are not necessary and not getting treatment that is appropriate for non-MS issues.
One common complaint many MS patients make is skin sensation abnormalities, like pain, tenderness, burning, itching, or numbness. These symptoms are called “dysesthesias”. The scalp is a prevalent location for dysesthesias. These scalp sensations often last for months or even years.
When there is scalp pain due to MS, it is “neuropathic” and arises from nerve damage (stripping of the myelin sheath- the protective coating- of the nerves in the brain and spinal cord). This damage slows the conduction of normal signals to the brain and may result in the dysesthesias. Up to 25% of MS patients experience neuropathic pain and this may be the cause of scalp pain, itching, burning, numbness and tingling, often of the scalp. New dysesthesias may be part of a relapse.
The same symptoms of the scalp can be due to skin problems such as allergies, psoriasis, contact dermatitis, or skin infection, often along with a rash. Some non-MS related itching may still be experienced more frequently in MS patients (i.e. Psoriasis), presumably due to autoimmune dysfunction. Further, some MS therapies may cause itching as part of an infusion side effect or from injections under the skin.
The treatment of managing scalp discomfort depends on whether it is neuropathic or unrelated to MS. MS-related scalp dysesthesias are often treated symptomatically with medications used in many conditions for neuropathic pain, such as certain antidepressants (like Cymbalta) and anticonvulsants (like Neurontin). These medications treat the symptoms only and do not address a potential flare. Numbness, unfortunately, cannot be treated symptomatically. If your doctor believes this is a flare, you may need steroids in addition. Non-MS related skin discomfort will be different depending on the cause and you may be referred to a dermatologist for clarification. Rashes or scaly, flakey skin are not typically related to MS.
BeCareLink can help you track your symptoms and measure your neurologic function to help you detect subtle changes that may represent increasing disease activity. The BeCare MS app can be used as a tool for you and your treating clinician to guide your therapy.