Findings of the scalp biopsy, including the type of inflammation present, location and amount of inflammation, and other changes in the scalp, are necessary to diagnose the type of cicatricial alopecia, to determine the degree of activity, and to select appropriate therapy. Clinical evaluation of the scalp is also important. Symptoms of itching, burning, pain, or tenderness usually signal ongoing activity. Signs of scalp inflammation include redness, scaling, and pustules. However, in some cases there are few symptoms or signs and only the scalp biopsy demonstrates the active inflammation. The overall extent and pattern of hair loss is noted and sometimes photographed for future comparison. A hair "pull test" is performed to see if growing, or anagen, where hairs are pulled out easily. The pulled hairs are mounted on a slide and the hair bulbs are viewed with a light microscope to determine how many are growing hairs and how many are resting hairs. In addition, if pustules are present, cultures are taken to identify which microbes, if any, may be contributing to the inflammation. A thorough evaluation that includes all of these parameters is important in diagnosing a cicatricial alopecia and in identifying features in individual patients that will help the selection of therapy. New diagnostic techniques, such as trichoscopy may be used for non-invasive differential diagnosis of cicatricial alopecia. Diagnosis and treatment of cicatricial alopecias is often challenging.
Drug and alcohol use can contribute to pruritus as well so it is worthwhile to gather a social history. Those who use cocaine and amphetamines may experience pruritus due to feelings of abnormal cutaneous sensations called delusions of parasitosis, also known as "meth mites". Opioid users can also experience pruritus so examining a patients medication list can be beneficial. Diagnostic criteria
The French Psychodermatology Group is a subgroup of the French Society of Dermatology made up on psychiatrists, dermatologists and psychologists. They met in 2007 to propose diagnostic criteria for this disease in hope of preventing further misdiagnosis of this condition. They believed the term "functional itch disorder" was the best phrase to describe this condition, avoiding the use of the word "psychogenic". To diagnose a patient with functional itch disorder, the patient should meet three required criteria and three of seven optional criteria.Diagnostic Criteria:
3 Required criteria
Localized or generalized pruritus without a primary skin lesion
Chronic pruritus, characterized as being greater than 6 weeks
There is no somatic cause present
7 Optional criteria (need 3 to diagnose)
A chronological relationship of pruritus with one or several life events that can have psychological consequences
Changes during the nighttime
More present during rest or inaction
There is a coupled psychological disorder
Pruritus that could be improved with pyschotropic drugs
Pruritus that could be improved by psychotherapies

Treatment
The treatment for this condition has not been well studied but the most common options are psychotherapy and medicines geared toward psychiatric conditions. Stress reduction and relaxation techniques have also been shown to be helpful for alleviating this condition.