Prurigo Nodularis on Scalp — Identification and Treatment | MyPrurigoTeam

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Prurigo Nodularis on Scalp — Identification and Treatment

Medically reviewed by Raj Chovatiya, MD, PhD, MSCI
Written by Ted Samson
Posted on March 22, 2023

Prurigo nodularis (PN) — also called nodular prurigo — is an inflammatory skin condition that can cause intense itching anywhere on the body. Some people living with PN experience this irritating sensation on their scalp, which can be a continual source of discomfort and aggravation. Managing itchiness on the scalp can sometimes be more difficult than managing it on other parts of the body: Hair can interfere with applying some topical treatments. A topical treatment is applied to a particular part of the body, for example, on the skin or scalp.

Members of MyPrurigoTeam have talked about how having an itchy scalp from PN affects their lives. “Drives me nuts. It affects my scalp,” one member shared. “Difficult to find any kind of med that helps the itch without messing up your hair. In addition to hair loss, screws up my entire life — social, emotional, etc. I just want to be isolated to not be embarrassed by any clue that my scalp is a disaster. My hairstyle is nowhere near what I want. The constant itch is mind-numbing.”

Your dermatologist can help you identify the root cause of any scalp itching and find an effective treatment. (Adobe Stock)


Although scientists have not yet found a cure for prurigo nodularis, there are ways to treat and manage symptoms, including itchy scalp.

How Prurigo Nodularis Affects the Scalp

Pruritus (itchiness) is the main symptom of PN. For some people, it’s constant. Other people experience it on and off. Either way, the intense itchiness naturally drives people to scratch the affected area to find relief. Unfortunately, scratching can make the problem worse — it eventually causes papules, nodules, and scaly skin patches to form.

These resulting lesions can cause even more intense itchiness, contributing to what’s called an itch-scratch cycle: The more you scratch, the more you itch, driving you to scratch even more. Scratching can sometimes cause the nodules to break open and bleed, potentially leading to infection or scarring.

PN symptoms most commonly affect the arms, legs, abdomen, back, and buttocks — but the condition can also affect the scalp, as many MyPrurigoTeam members can verify. “I was just diagnosed yesterday, and my scalp is covered,” one member shared. “The pain and itching are unbearable.”

Scratching an itchy scalp can lead to the aforementioned nodules and scars. Lesions may be more common in the occipital region of the scalp, which is the back of the head. Scratching and rubbing can also damage hair follicles, which can lead to hair loss.

“I know exactly how you feel,” one MyPrurigoTeam member told another. “I’m having a flare-up right now. Every morning when I wake, there’s hair on my pillow. I’ve been battling this since I was 25. I’m 57 now. My hair is so thin, I call it see-thru hair 😄.”

Other Causes of Itchy Scalp

It’s unclear just how common scalp-related itching is specifically in people with PN — or other conditions, for that matter. The symptom is common in dozens of health conditions, many of which are related to PN.

​Other conditions that can cause or contribute to an itchy scalp:

Many different conditions — including several related to prurigo nodularis — can cause scalp itching and lesions. This photograph shows a case of atopic dermatitis. (CC BY-NC-ND 3.0 NZ/DermNet)
  • Other skin conditions, like psoriasis, atopic dermatitis, and allergies (e.g., to particular hair care products)
  • Neuropathic (nerve-related) conditions, like migraine and brain and spinal cord injuries
  • Systemic conditions (those that affect the entire body), including lymphoma and liver disease
  • Mental and emotional health conditions, such as anxiety disorders and depression

That’s not to say an itchy scalp means a person has any of the above conditions, but it’s worth noting that the symptom can have other causes. Also, it’s possible to have more than one skin disease that can cause an itchy scalp, along with other symptoms similar to those of PN.

If you’ve been diagnosed with PN and start developing intense itchiness on your scalp — or any other new symptoms — contact your primary doctor or dermatologist. Knowing the root cause is an important step toward treatment.

Managing Itchy Scalp With Prurigo Nodularis

Treatment for PN focuses on reducing itching, which can stop the itch-scratch cycle and give your skin a chance to heal. There’s a range of treatments a doctor may recommend, depending on the severity of your condition.

You can read more about the various treatments available for PN. Some options can help with an itchy scalp, including:

  • Corticosteroids — Topical and intralesional (injected directly into a skin lesion)
  • Immunosuppressants
  • Anticonvulsants
  • Antihistamines
  • Anesthetics (lidocaine or pramoxine, but only in topical form)
  • Phototherapy
  • Vitamin D
  • Cryosurgery or cryotherapy

Following are specific treatments and approaches to help with an itchy scalp.

Shampoos

Some people find relief from an itchy scalp using over-the-counter (OTC) shampoos. Researchers recommend using a shampoo with a pH — a measure of how acidic or alkaline a substance is — between 4.5 and 6.0. Using shampoo in this pH range can help reduce the secretion of enzymes called serine proteases that cause itchiness. Ingredients such as glycerin and panthenol can help with dryness. Menthol and camphor can provide cooling relief.

If you try a shampoo with menthol, you might want to test it first. Menthol sometimes causes skin irritation.

MyPrurigoTeam members have discussed hair care products they’ve found helpful. “My scalp, for the first time in years, has no scabs on it. But I have a bald spot the size of a silver dollar that is smooth as a baby’s butt. No hair growing back at all,” a member wrote. “I use dry scalp shampoo and conditioner by Dove.”

“For my scalp, I use Head & Shoulders shampoo,” another member said. “It does really help.”

Topical Treatments

Several types of topicals can ease scalp itchiness. Researchers have found that moisturizers, lotions, and emollients containing capsaicin — derived from chili peppers— are effective in treating scalp itching from prurigo nodularis. Other ingredients recommended for treating itching include menthol, phenol, camphor, and pramoxine, as well as glycerin and panthenol.

Topical anesthetics containing lidocaine, prilocaine, polidocanol, or pramoxine may also help.

Among prescription treatments, researchers have also found that topical calcineurin inhibitors — such as tacrolimus and pimecrolimus — can effectively ease scalp pruritus. They work by slowing down the activity of a molecule called calcineurin, which is involved in regulating the immune response.

Doctors sometimes prescribe topical corticosteroids to provide relief from itching. These prevent your immune system from causing inflammation or other abnormal reactions. However, more research is needed on the effectiveness of corticosteroids for treating an itchy scalp.

Applying topicals thoroughly to the scalp can be difficult because hair can get in the way. The American Academy of Dermatology Association (AAD) has a video with guidance on the best way to apply topicals to your scalp. The suggested steps are as follows:

  1. Part your hair in the middle, then apply the medication thoroughly to the skin all along the part. Use a dropper for a liquid medication or, for a cream or foam, dab some onto your finger and rub it in.
  2. Part your hair 2 inches to the right of the center part, then apply the medication along the part.
  3. Repeat to the left of the center part.
  4. Part your hair over your right ear, then apply the medication along the part.
  5. Repeat above your left ear.
  6. Wash your hands thoroughly when you’re done.

Other Tips for Managing Itchy Scalp

In addition to using OTC and topical treatments, there are other steps you can take to help control your scalp-related PN symptoms.

Prevent Scratching

One important step is to avoid scratching, which can worsen itchiness in the long run and lead to nodules and infection. A lightweight, breathable head covering could help you avoid directly scratching your skin and minimize damage.

Avoid Triggers

Researchers have identified several triggers for PN that can make itching worse, including:

  • Heat or humidity
  • Sweating
  • High stress levels
  • Dry air
  • Certain fabrics, such as polyester or wool
  • Skin and hair care products that contain irritating ingredients — Look for “fragrance-free” on labels.

If you experience severe scalp itching, it’s especially important to avoid getting too warm and sweating excessively.

Stay Cool

In addition to the aforementioned cooling products and avoiding heat and humidity, cold compression may provide relief for an itchy scalp. The AAD recommends applying an ice pack or cold, wet cloth to the affected area for five to 10 minutes or until the itching lessens.

Also, when showering or bathing, use lukewarm water instead of hot, and limit your bathing time to 10 minutes.

The Bottom Line

Prurigo nodularis can be difficult to treat, but there are several options available. Talk to your doctor to determine the best choice for you based on the severity of your condition. With proper care and management, it is possible to relieve the symptoms of prurigo nodularis and enjoy a better quality of life.

Find Your Team

On MyPrurigoTeam, the social network for people with prurigo nodularis and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with prurigo nodularis.

Do you have an itchy scalp from prurigo nodularis? Do you have any tips to help manage it? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on March 22, 2023
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    Raj Chovatiya, MD, PhD, MSCI is an assistant professor of dermatology at Northwestern University Feinberg School of Medicine in Chicago, Illinois. Learn more about him here.
    Ted Samson is a copy editor at MyHealthTeam. Learn more about him here.

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