Fight the Flake: Seborrheic Dermatitis Scalp Treatment During Chemo

October 22, 2021
Fight the Flake: Seborrheic Dermatitis Scalp Treatment During Chemo

Originally published on Happy 2nd Birthday 

In movies and on television, those experiencing hair loss from chemotherapy usually just look like their beautiful Hollywood selves with the addition of a beanie hat or head scarf that  indicates baldness underneath. But in reality, there is nothing glamorous about the temporary baldness (along with the loss of eyebrows, lashes, and other body hair) that comes along with cancer treatment.

Among the least glamorous components of hair loss during chemotherapy are the pain and flakes as hair falls out. While most patients undergoing chemotherapy for cancer often have bigger pain and worries than those that come from hair loss, many also find it emotionally difficult—so improving quality of life through skincare tailored to their needs during chemotherapy can absolutely make a difference. 

Here are a few tips from top dermatologists on how to care for your scalp during chemo in order to both soothe pain and reduce flaking.

Not all hair loss during chemotherapy is the same

According to Dr. Jonathan Leventhal, director of the Onco-Dermatology Program at Smilow Cancer Hospital at Yale, “Many chemotherapies can result in hair loss, particularly those used to treat breast cancer and gynecologic cancers.” But whether patients experience partial or total hair loss, along with the loss of eyebrows, lashes, and other body hair, varies from patient to patient, even among those taking the same drugs, according to the American Cancer Society website.

In addition to variations in severity of the hair loss, the response of the scalp is also different for everyone. “Chemotherapy can also result in dryness and flaking, known as seborrheic dermatitis, as well as pustules and acneiform rash on the scalp, which is known as folliculitis,” says Dr. Leventhal. These rashes, as well as the hair loss itself, may range from painful to just a bit irritating, but no matter how severe, there are definitely some steps patients can take for better scalp care during chemo.

Consider scalp cooling options during chemotherapy

Some people choose to use cold caps or scalp cooling systems during chemotherapy. This is a great option for people who are anxious with hair loss as they help less of the chemotherapy drugs get to the hair follicles. Although these cooling caps and scalp cooling systems can be pricey, there are options available to help cancer patients pay for these supplies. Talk to your medical team about whether this is a good decision for you, given your unique situation and needs. 

Be gentle & use gentle skincare products.

For those who still have hair, Dr. Leventhal recommends a gentle, fragrance-free shampoo that also combats dandruff, such as Neutrogena, Selsun Blue, or Head & Shoulders. But for those who are dealing with total hair loss, an even gentler option is to use the same safe, fragrance-free washes used to wash sensitive facial skin, says Dr. Nicole LeBoeuf, director of The Program in Skin Toxicities from Anticancer Therapies at Dana-Farber/Brigham and Women’s Cancer Center.

And just as it’s important to moisturize facial skin, the same advice stands for scalps. Both doctors recommend what Dr. LeBoeuf calls a “nice, bland thick cream” to fight scalp flakes, including those from Cetaphil, Cerave, Neutrogena, Aveeno, and Eucerin.

Don’t avoid the sun--just make sure you’re protected! 

The dry air of the winter season can make your dermatitis worse, but the sun might actually help. The yeast that builds up on the scalp doesn’t survive well in UV light. So don’t avoid the sun, just make sure that you are appropriately covered and managing the amount of time you’re allowing yourself sun exposure. Without sunscreen, it’s not recommended to be in the sun longer than twenty minutes to avoid sunburn and skin cancerous growths. 

Whatever you do, don’t pick--or scrub! 

It’s a natural impulse to want to fight dry, flaking skin with a bit of exfoliation, especially since there are so many new sea salt scrubs for scalps popping up everywhere from Sephora to hairdressers’ product displays. However, for cancer patients, those scalp scrubs could actually cause more problems than they solve.

“When we’re dealing with thick, scaly skin, scrubs are usually what we turn to,” says Dr. LeBoeuf. “But that’s the opposite of what patients generally need to do.” Scalp scrubs can actually disrupt the healing process and create more irritation in the long run even if it feels good to scratch away all that itchy skin in the moment. 

Sticking to gentle cleansers, shampoos, and moisturizers is the way to go, and for skin that is broken, aggressively inflamed, or really thick with scales, consulting a dermatologist to explore prescription options is a much better bet than searching for solutions for scalp care during chemo on your own.

Wash your skin regularly. 

Understanding how to care for your scalp during chemo can often be counterintuitive. In fact, all those old tales about skipping washes to make hair grow faster can actually hinder your success and create a yeast buildup on the scalp that results in itching and unsightly flakes as hair returns.

Dr. LeBoeuf says she has seen many patients who are scared to disrupt the hair regrowth process after chemo and therefore are going days between washes. Those patients then sometimes deal with flaky, scaly scalps. For these patients, Dr. LeBoeuf recommends washing more frequently, either every day or every other day. Washing frequently does not slow down hair growth, but it can help with the overgrowth of yeast that is potentially causing the flakes.

While it’s important to stay showered, you can change up your routine by taking shorter showers and avoiding hot water. Warmer water showers are less likely to irritate the skin on your scalp further.

If you’re unsure, ask for help! 

One of the easiest solutions for seborrheic dermatitis scalp treatment during chemo is oftentimes one of the most overlooked: Ask for help! Cancer treatment can be daunting, but consulting a dermatologist for tips on how to manage skin and scalp concerns can really reduce anxiety around changes to your body, resulting in better quality of life during a very challenging time.

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