Itching that occasionally happens after  a hair transplant surgery  is usually due to post-operative crusting. Sometimes it also happens because of excessive drying of the scalp from aggressive shampooing, infections, an allergic reaction to topically applied agents, or a previously existing skin condition (such as psoriasis).

As we all know, itching is the sensation that causes one to “scratch.” In the “evolutionary sense” scratching was the method  by which we removed foreign objects (such as insects) from the surface of our skin. Unfortunately, humans has not evolved to be able to differentiate the “useful” itching, produced by insects, from the problematic itching, caused by the crusts or scabs that form when the serum that exudes from all skin wounds , dries up.

Itching should always be avoided after a hair transplant because, in addition to being a nuisance for the patient, it is invariably associated with scratching (conscious or unconscious), and this increases the chance of dislodging grafts, opening donor incisions, and bacterial infection.

It is possible to decrease the incidence of itching after a hair transplant by post-operative care aiming  to promote wound healing. This includes using an antibacterial ointment along the suture line to keep it greasy for a few weeks after the surgery. Patients sometimes complain of the greasiness, but rarely the itch. In the recipient area, we can decrease the formation of crusts by gentle washing of the recipient area twice a day following the surgery and each day thereafter. A mild shampoo is used to facilitate the removal of the crusts. If the crusts are not removed in the first two days, they will generally persist until the hairs that they are stuck to are shed.

For the occasional patient that does itch in spite of these measures, after infection and contact dermatitis have been ruled out, hydrocortisone ointment can be  applied  to the suture line or the recipient area. The key is to keep this scalp greasy after the hair restoration.