From the Guidelines
For cancer patients experiencing an itchy scalp, the most effective treatment approach is to use gentle, fragrance-free shampoos and moisturizing products, and consider oral antihistamines like loratadine (10mg daily) for mild-to-moderate pruritus, as recommended by the most recent guidelines 1. When managing itchy scalp in cancer patients, it's essential to consider the underlying cause of the itchiness, which can be related to chemotherapy, radiation, or the cancer itself affecting skin cells and nerve endings.
- Gentle, fragrance-free shampoos like Neutrogena T/Gel or Head & Shoulders Sensitive should be used, and hair should be washed with lukewarm water, not hot, and limited to 2-3 times weekly.
- Moisturizing products like CeraVe or Eucerin should be applied to the scalp after washing to help soothe and calm the skin.
- Over-the-counter options like hydrocortisone cream (0.5-1%) can be applied twice daily for up to one week, but it's crucial to consult with an oncologist before using any new medications.
- Oral antihistamines like loratadine (10mg daily) can be recommended as the first choice for systemic therapy for pruritus during daytime, while first-generation antihistamines like diphenhydramine (25-50 mg daily) may be considered for nighttime use due to their sedative properties 1.
- For immediate relief, cool compresses can be applied to the scalp for 10-15 minutes, and scratching should be avoided to prevent worsening irritation and potential infection.
- If symptoms persist or worsen, consulting an oncologist is necessary, as prescription-strength medications like stronger corticosteroids or specialized treatments may be required, especially if the itching is severe or accompanied by visible scalp changes.
From the Research
Itchy Scalp in Cancer Patients
- Itchy scalp can be a symptom of various conditions, including skin diseases such as psoriasis and eczema, which can be treated with topical agents like coal tar and corticosteroids 2, 3.
- Coal tar has anti-inflammatory, antibacterial, antipruritic, and antimitotic effects, making it a potential treatment option for itchy scalp in cancer patients 2.
- However, coal tar contains carcinogens, and its use has been associated with an increased risk of cancer in occupational and animal studies 2, 3.
- A large cohort study found no increased risk of non-skin malignancies or skin cancer in patients treated with coal tar compared to those treated with dermatocorticosteroids 3.
- Topical corticosteroids are another common treatment option for skin conditions, but there is limited evidence on their long-term use and risk of skin cancer 4.
- Comparative studies have evaluated the efficacy and safety of coal tar versus other topical agents, such as calcipotriol and betamethasone dipropionate, in the treatment of chronic plaque psoriasis 5, 6.
Treatment Options
- Coal tar-salicylic acid ointment and calcipotriol/betamethasone dipropionate ointment have been compared in terms of efficacy and safety in the treatment of limited chronic plaque psoriasis 5.
- Calcipotriol has been shown to be more efficacious than coal tar in reducing disease severity and preventing relapse in patients with plaque psoriasis 6.
- The choice of treatment should be based on individual patient needs and medical history, and patients should be monitored for potential side effects and interactions with other medications 2, 3, 5, 6.