What Can I Do to Alleviate the Itching from Aldara After MOHS Surgery?

Itchy red rash after imiquimod (Aldara or Zyclara) application, particularly in the area where Mohs surgery of a non-melanoma skin cancer is performed, can be expected. Imiquimod typically respects healthy tissue so the inflammatory reaction often reflects the underlying precancerous or even skin caner potential. Despite theoretically concern that application of cortisone cream may diminish the effect of imiquimod, this is something I have my patients do routinely to achieve comfort and I have not witness any degradation of clinical efficacy.
 

I doubt the itching you have is from the Mohs surgery. Depending on the reaction your skin is demonstrating from the Aldara cream, some patients do have more itching than others. The Aldara works by stimulating your skin's immune system to help get rid of precancerous cells that are not even clincially visible. This inflammation might be the cause of your itching. Call the physician who prescribed the Aldara and let them recommend a treatment that may help you feel more comfortable. They may want to see you to be sure you are not developing an infection, which would be very rare. They may tell you how to use a dilute acetic acid compress, which can help keep the skin clean and may help reduce some itching, but could overdry the skin too, so don't do this without seeing your dermatologist.

It is not uncommon to get an "eczematous" (inflamed, red and itchy) area after and during treatment with Aldara. Typically, this is treated with a cortisone ointment. On the face, the strength of the ointment should be limited to over the counter or non fluorinated steroid ointments. In either case, you should make the doctor aware of the symptoms and treatment.

I would call the dermatologist who performed the Mohs chemosurgery. In the meantime you might try Prax Lotion OTC or Aveeno Anti-Itch Lotion with Oatmeal. If your dermatologist permits you might stop the Aldara cream for a few days. You may have developed an allergic contact. If the rash resolves, but recurs upon resumption of Aldara, you have your answer.
We use Aldara not only to stimulate the immune system to prevent future skin cancers, but also, its use diminishes the post-surgical scar.