In our patients (Table), the most common symptoms of scalp dysesthesia were burning (7 patients), pruritus (6 patients), or both burning and pruritus (2 patients). Two patients described a sensation of “bugs crawling” on the scalp. Two patients had concurrent chronic telogen effluvium, and 2 other patients reported subjective hair loss that was not further described in the medical records. Two patients reported chronic neck pain, and 1 patient had a history of a C6-C7 fusion surgical procedure. None of the patients had worsening or improvement of the symptoms with certain head positions or exercises. The symptoms were diffuse in 10 patients and were localized to various regions of the scalp in 5 patients, including the frontal, vertex, occipital, parietal, and temporal scalp. One patient with diffuse scalp burning also reported burning in the right arm. The duration of symptoms before presentation ranged from several months to 8 years. All 15 patients were women of white race/ethnicity, with an age range of 38 to 83 years. Two patients had a diagnosis of depression, and 1 patient had a history of anxiety. None of the patients indicated that stress had any influence on their symptoms. The physical examinations were unremarkable for primary lesions, although 3 patients had secondary excoriations in the symptomatic areas of their scalps. The differential diagnosis for scalp pruritus includes many common dermatologic conditions, including seborrheic dermatitis, psoriasis, scarring alopecia, tinea capitis, pediculosis, contact dermatitis, allergic dermatitis, acne, and folliculitis. The physical examination has a crucial role in the diagnosis of many of these conditions, and a key component to diagnosing scalp dysesthesia is the lack of objective primary skin findings.