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Baldness Hair loss Trichodynia Dr. Alfredo Rebora, Department of Dermatology, University of Genoa, Viale Benedeno XV, I-16132 Genova (Italy) No symptoms have ever been reported to accompany the development of baldness. There are patients, however, who, while complaining of hair loss, claim that their hair has become painful. We describe such discomfort and we propose the term trichodynia for it. (The term trichodynia was coined by C. Del Forno, MD, in April 1995.) Two hundred and twenty-two consecutive women seeking advice for hair loss were examined. In particular, they were asked about any discomfort, pain or paresthesia in their scalp or hair. Pruritus was not considered. Hair loss was evaluated by the pull test, daily count and wash test. In brief, 5 days after shampooing, hairs were ‘combed’ by fingers and the number of hairs remaining in between them was registered. Hairs found on the pillow, comb and shoulders during the day were also counted (daily count). Five days after shampooing, hair was shampooed in a sink whose hole had been covered by a gauze and the number of hairs remaining in the gauze was recorded. A trichogram was also made according to the well-known procedure. Seventy-six women (34.2%) complained of trichodynia. Most commonly the symptom was described ‘as if the hairs were bent in the wrong way’, more rarely as ‘stitches’. There was no difference of age between patients with trichodynia and those without (37.3 and 37.7 years, respectively). No relationship was found between the onset of trichodynia and onset of hair loss. In addition, patients with trichodynia did not show a severer hair loss than those without. In particular, with the wash test, patients with trichodynia averaged 207 hairs (median 150) versus 173 hairs (median 120) counted by those without (t= 1.345; p > 0.05) and 68% of patients with trichodynia counted 100 or more hairs versus 57% of those without (Fisher’s test p = 0.007). Also, the daily count, the pull test and the percentage of telogen hairs showed no difference. Lastly, there was no relationship with the severity of hair thinning, 17% of patients with trychodinia having Ludwig alopecia grades I-III versus 21% of patients without. In women complaining of hair loss, it is always difficult to discriminate between reality and delusion. In doubtful cases, most dermatologists tend to favour the second choice. We decided to give credit to the claim and took to the idea that hair loss is painful in about one third of patients.