What do you recommend for scalp care and in particular, for pruritic (itchy), lesional skin?


The scalp care in mycosis fungoides and Sézary syndrome differs based on whether there is pruritus (itching) without lesions or pruritic lesions. The care also differs if the lesions are patches/plaques, or if they are nodules.

For itching in general, the physician would likely try to determine if this is localized (in one area) or diffuse (multiple different areas of the body). If localized, we will attempt local anti-itch treatments, such topical steroids. If diffuse, we will usually try systemic anti-itch agents, such as gabapentin.

However, if there are associated lesions as well, it is important to know that anti-itch agents such as gabapentin are temporary measures. The true treatment for this is the treatment of the condition itself --- the regimen your physician has determined is needed for your disease.  

In patches and plaques, the associating flaking can contribute the itch. Your physician may suggest various shampoos such as T/SalⓇ or T/GelⓇ to help with that temporarily while your treatment is beginning. However, if there are areas that are ulcerated or open sores, they may suggest you meet with a wound care specialist for training on appropriate dressings until those areas resolve.

Answer provided by:
Dr. Farrah Abdulla
Director, Cutaneous Lymphoma
University of Chicago


For scalp care, I would recommend a gentle shampoo without fragrances, such as a baby shampoo to wash the scalp that is normal, not scaly or itchy.
If the scalp is scaly and itchy, there are a number of shampoos that can help with discomfort. Tar shampoos (Neutrogena T/GelⓇ or other over the counter tar shampoo) left on the scalp for 5 minutes before thorough rinsing can be helpful for scaliness and itching. Shampoo with salicylic acid can be helpful for removing excessive scales. If scaliness and itching persists despite using tar shampoo, prescription topical steroid solution can be applied and messaged onto the scalp to decrease scaliness and itching.

And, what is the difference between pruritic and lesional?

Pruritic means itchy. Lesional is an adjective that defines an abnormal area on the skin that has a rash or growth. Pruritic lesional skin is a specific site on the skin that is itchy. 

Answer provided by:
Henry K. Wong, MD,PhD
Professor and Chairman
Department of Dermatology
UAMS College of Medicine