Scalp Pimples? What Causes Scalp Acne and How to Treat It

Scalp Pimples? What Causes Scalp Acne and How to Treat It

scalp acne

We have all had to deal with a blemish or two (or more) on our face. Many people also get pimples on their back or other places on their body.

But, despite being relatively common, pimples on the scalp or scalp acne is rarely talked about.

Scalp acne only really differs from other forms of acne based on its location on the body. Instead of occurring on the face, back, or other body parts, it occurs along the hairline and may even extend further up onto the scalp.

In this article, we will give you the rundown on the causes of, treatments for, and measures to prevent scalp breakouts.

Scalp acne: Causes, treatments and prevention

Before we get into scalp acne:

There is an important distinction we need to make between two common disorders, scalp acne and scalp folliculitis.

Both are visibly similar with inflammatory papules, pustules, or nodules. Both of these conditions have acne-like symptoms, but they have different pathogenesis (cause), and thus, they are treated with different therapies. To distinguish the two, let’s take a look at how scalp acne develops and how this differs from scalp folliculitis.

Scalp acne causes

Acne, whether it is on your scalp or somewhere else, is a disorder that affects the pilosebaceous unit (the hair follicle and shaft, the sebaceous gland, and the erector pili muscle). The sebaceous gland produces sebum, your skin’s natural oil, which moisturizers your skin and hair and also helps to form a protective barrier.

Hormones can cause these glands to become enlarged and produce more sebum; this happens most commonly during the teen years and pregnancy but can also occur at other times.

The bacteria known as Propionibacterium acnes (P.acnes), which is usually present on the skin of healthy humans, uses sebum as a nutrient that helps the microorganism to proliferate (multiply). Those with more sebum will have higher counts of P. acnes.

As the bacteria population grows, the body will begin to attack it with white blood cells that damage the follicle and lead to cell debris becoming clogged in the pore. The damage and debris result in the blemishes that appear with acne, most commonly whiteheads and blackheads (also known as comedones) as well as papules and pustules.

For more information about types of acne lesions and how to treat them, check out our article on the best natural and organic skincare products for acne.

Scalp folliculitis, on the other hand, is limited to the hair follicle and is usually caused by staphylococcus aureus (S.a) – yeast, mites, or other non-infectious agents. The result is typically small, extremely itchy red bumps or nodules that are deeper in the skin and lead to severe itching. Folliculitis can occur anywhere on your body where there is hair, but the scalp variety is so named because it occurs at the front hairline and may spread further up onto the scalp.

Keep in mind that either of them can present with papules, pustules, and nodules. Thus, the type of lesions cannot be used to differentiate them. Scalp folliculitis comes in many forms, and researchers are still investigating each one.

Because scalp acne and scalp folliculitis have different pathogenesis and therapies, it is essential to determine which one is causing the inflammatory lesions, so that they can be treated accordingly.[1]

If you think you may have scalp folliculitis, keep reading. We will cover it more below after we discuss scalp acne and give you some at-home remedies you can try.

However, you may need to seek the advice of a medical professional such as your family doctor or a dermatologist to alleviate the condition.

The information provided here, both for scalp acne and folliculitis, is for your information only and does not replace the advice or treatment of a medical professional. If you are having trouble riding your skin of either condition, you should enlist the help of a healthcare provider such as a general practitioner or a dermatologist.

Now that we have looked at the cause of scalp acne, we can discuss some of the treatment options.

Scalp acne treatments

scalp-acne-treatments

There are two tiers of treatments you can try. The first being at-home or ‘over the counter’ remedies, and the second is prescription treatments that will require a trip to the doctor. If you have a mild or moderate case, you can likely treat it at home without the help of prescription medication.

However, if you find these therapies ineffective, you want to get the advice of a physician as the condition could get worse, or your scalp acne could be the symptom of another ailment.

Treating scalp acne is not much different than treating acne on the rest of your body; the most significant barrier is your hair. Thus, you are likely going to use shampoo rather than topical products applied to the skin. For more severe cases, doctors may prescribe topical or oral treatments.

Treatment Tip:

Unless directed by a medical professional, only use one treatment at a time so you can accurately judge the efficacy of each product.

You can treat scalp acne using the same active ingredients as other acne because they are both mediated by the same three conditions: sebum levels, microorganisms, and clogged pores and follicles.

So, let’s take a look at some of the conventional therapies used to treat scalp acne.

Over the counter remedies: Try these common ingredients for treating scalp acne

Below are some of the same ingredients that are frequently used to treat acne on the face. We have reviewed the most common active ingredients and provided you with some shampoos that employ their use to fight scalp breakouts.

Common OTC ingredients include:

  • Salicylic acid exfoliates your scalp to remove dead skin cells, so they do not clog pores and cause acne. It also helps to kill bacteria due to its low pH values.[2] Try: Neutrogena T/Sal Shampoo
  • Glycolic acid also exfoliates the skin and has antibacterial properties to kill P.acnes in the pores and follicles on your scalp.[3] Try: RX Systems Volumizing Glycolic Shampoo
  • Ketoconazole or ciclopirox are antifungal agents that are regularly used in antidandruff shampoos. Ketoconazole stops P.acnes from metabolizing sebum, which both inhibits its growth and reduces the inflammation caused by P.acnes.[4] They are also useful for scalp folliculitis. Try: Nizoral
  • Tea tree oil has antibacterial properties that can help fight acne-causing bacteria.[5] Try: Trader Joe’s Tea Tree Tingle Shampoo & Conditioner
  • Jojoba oil is all about controlling sebum levels. Jojoba oil won’t likely get rid of the acne on its own, but adding it to your shampoo can help hydrate your scalp and hair while controlling the amount of sebum produced and soothing inflammation.[6] We will discuss this one more in the next section on preventative measures, but you can start using it while treating scalp acne. Try: Majestic Pure

Each of these shampoos can help to treat scalp acne causes. However, which one works best for you may be a case of trial and error. Unless you experience more than mild irritation, give each shampoo four to eight weeks to see if it reduces acne blemishes (comedones, papules, and pustules). If there is no improvement, you may wish to try a different shampoo.

If you have tried a few with no effects, it is time to get a professional involved.

Scalp acne treatment tip:

Benzoyl peroxide is a conventional treatment for acne on the face and body, but it is not commonly used for scalp acne as it bleaches hair.

Caution:

Alpha hydroxy acids like salicylic acid and glycolic acid, as well as the antifungals and antibacterials (like tea tree oil), can cause mild irritation on the skin. Adding in a soothing conditioner or other treatment like jojoba oil can help reduce the side effects. If the irritation is more than mild, seek the advice of a dermatologist.

Use medicated shampoos every two to three days

Because many scalp acne shampoos target sebum production, using them too often can dry out your scalp and hair. Try limiting their use to once every two or three days and look for a sulfate-free shampoo, if possible. Many shampoos require that you leave them on the scalp for 3 to 5 minutes, giving them time to work. Make sure to rinse both your scalp and face thoroughly after application.

There are a lot of options out there that use the above ingredients. Don’t feel limited to the ones listed here. Use your knowledge of your skin and hair to find the right product with one of the known active acne-fighting ingredients we’ve discussed to get the best shampoo for your hair and scalp.

If you have tried over the counter (OTC) medicated shampoos with no avail, it is time to get a dermatologist involved who can evaluate the situation and provide a tailored treatment plan. Remember that what appears as scalp acne could be folliculitis or another condition.

Some common underlying causes that may present like or have scalp acne as a symptom include:

  • Skin cancers
  • Deep infections or abscesses
  • Seborrheic dermatitis (scales, redness, and dandruff)
  • Cysts

Do not try to diagnose these conditions on your own; leave that to an expert.

Prescription remedies: Talk to a dermatologist

Talking with a dermatologist will allow them to assess the severity of your acne and its potential causes, giving them the information they need to design a treatment regimen that is right for you. Here we will give you a quick look at some of the standard therapies that dermatologists use when treating scalp acne.

Conventionally prescribed treatments include:

  • Topical antibiotics can be used to help fight off infections.[7]
  • Steroid creams are often used to reduce redness and irritation but do not treat the underlying causes. They are used mainly to manage the appearance of inflammatory acne.[8]
  • Oral medications, such as antibiotics and antihistamines are also used to kill acne-causing bacteria and reduce redness, irritation, and inflammation when topical applications have proven ineffective or are not well tolerated by patients.[9]
  • Oral isotretinoin is still the go-to treatment for severe acne cases, whether it be on the body, face, or scalp.[10] They are most commonly used when the above treatments fail.[11]
  • Light therapies are a range of laser and light therapies, including photodynamic therapy (PDT) and photoneumatic therapy. They use red or blue light to kill the offending bacteria and shrink sebaceous glands. Your doctor may also apply a photosensitizing agent to make the treatment more effective. PDT has the best supporting evidence for its efficacy in treating acne because there are just more quality studies on its use. Their application has mainly been tested on the face and back, but they are effective for some. They are generally used as an alternative therapy when other options fail or are not well tolerated.[12]
  • Steroid injections may be used if topical applications are not successful. They also alleviate inflammation and the resulting redness and irritation and can shrink larger nodules and cysts. Due to their possibility for severe side effects, they are not used to treat widespread breakouts.[13]
  • Physical extractions that clear pores are also used to alleviate stubborn blemishes. Do not try this one at home as it will likely make your acne worse if not done by a trained professional.

If OTC therapies have proven ineffective, seek out a dermatologist to help design a treatment plan for your scalp acne and check that there aren’t any other underlying conditions leading to breakouts.

A dermatologist will also be able to tell you if you may be experiencing scalp folliculitis rather than scalp acne.

Scalp acne prevention

scalp-acne-prevention

Once you have got things under control, you are going to want to prevent further scalp breakouts. In this section, we will discuss some of the things you can do to keep scalp pimples at bay.

Avoid oil-based products

Because a buildup of oil is one of the leading causes of scalp acne, you want to avoid adding to that problem by applying even more oil to your face and scalp. One exception may be jojoba oil, which can help to limit the natural sebum production.

It seems counterintuitive, but jojoba is a popular, oil-control product that can help reduce breakouts. Other oil-based products, on the other hand, are likely to make things worse.

Wash hair after working out or sweating

Washing your hair helps to remove oils and other debris that can clog pores. Especially after you work out, wear a hat or other headgear, or otherwise sweat.

Continue to use medicated shampoos & avoid comedogenic ingredients

If any of the above shampoos or a shampoo containing one or more of those ingredients were helpful, you should continue to use it 1 to 3 times per week to keep scalp pimples away.

CLn Shampoo is also another great option as it helps remove excess oils, impurities, and dead skin cells from the scalp. If these are too irritating for continued use, CLn Gentle Shampoo may be a good alternative.

Make sure you rinse products out thoroughly as buildup due to improper rinsing can lead to acne. You may also want to massage the scalp with your fingertips or a shampoo brush—but not fingernails as this will damage the skin and increase infections. A gentle scalp massage can help to clear pores of oil and impurities.

Avoid sulfate shampoos as they can leave a film behind that clogs pores and may increase breakouts.

Check this list of comedogenic ingredients for tips on other ingredients to avoid in hair and skincare products.

Skincare is highly personal, and how often you have to wash your hair is not the same for everyone. Washing too often or too little can lead to scalp acne. Experimentation will help you find the right frequency for your hair and scalp.

Avoid using too many hair products & wash them out

Hairsprays, gels, and especially oil-heavy pomades can leave pore-clogging residues on your scalp that lead to breakouts. Try to limit their use and don’t apply too much. Stick to the recommended amount or less, if you can. Make sure you wash them out before going to bed.

Wear looser fitting headgear

Tight-fitting hats and other headgear don’t give your scalp room to breathe and trap impurities close to the skin. This can contribute to scalp acne and scalp folliculitis. If you can, wear looser-fitting headwear.

Keep your pillow & sleeping area clean

Following on from the advice above, make sure to remove any hair products and makeup before going to bed as they can end up on your scalp as you sleep and can contribute to pore clogging and may buildup on your sheets and pillowcases.

Likewise, keep your pillows and sheets clean as they can deposit impurities back onto your skin and bread bacteria.

Watch your diet & keep a food diary

Foods rich in carbohydrates and sugars may increase the occurrence of breakouts. Other foods may also have this effect on your skin. So, keep a food diary and track breakouts and see if you can find a link.

There are also some nutrients that can help reduce breakouts by giving your body the resources it needs to fight infections and keep your skin balanced.

Eat foods rich in or add supplements that contain:

  • Vitamin A
  • Vitamin D
  • Omega-3 fatty acids
  • Dietary fiber
  • Antioxidants
  • Zinc

As with other acne types, it may be possible to eliminate your scalp acne and keep it gone by following these guidelines. However, it may also be the case that your scalp acne is something you will have to keep a handle on for some time.

Now we can switch gears for a moment and discuss the other possible cause of red itchy bumps around your hairline, scalp folliculitis.

Scalp folliculitis

scalp-folliculitis

We already discussed the pathogenesis (the development) of folliculitis above, and you should leave the diagnosis to a doctor.

However, if scalp acne treatments have proven ineffective, visit a dermatologist to check if you have folliculitis instead.

Scalp folliculitis risk factors

This condition has a few other names, such as acne necrotica miliaris or Propionibacterium folliculitis. It presents as small red itchy bumps around the hairline, and you may see a lot of lesions or only a few. They are itchy and often become sore and crusted. They can ooze pus, and you may also experience a burning or stinging sensation on the skin.

There are a few things that can damage hair follicles and lead to the onset of folliculitis on your scalp:

  • Frequently scratching or rubbing your scalp skin
  • Tugging on your hair (either with your hand or by wearing tight hairstyles such as ponytails or braids)
  • Friction from wearing hats, helmets, or other headgear frequently (especially if they are close-fitting or you sweat in them)
  • Shaving your head
  • A buildup of hair products
  • Acne or dermatitis on the scalp
  • Acne treatments including steroid creams and antibiotics
  • Washing your hair with hot water

Reducing these factors can help to calm and prevent folliculitis.

There are also a couple of risk factors you do not have control over:

  • Being a male with coarse or curly hair
  • Having a weakened immune system due to an underlying condition

Scalp folliculitis treatments

If you have a mild or even moderate case of scalp folliculitis, you may be able to treat it at home without prescription medications. Give these remedies a try, and if they are not sufficient, contact a dermatologist promptly.

Try these:

  • Cease any of the controllable risk factors above, i.e., stop wearing hats, or switch to ones with more breathability, stop wearing your hair in tight styles, wash your hair with lukewarm water, etc.
  • If you shave your head, stop. If your folliculitis clears up, you may need to revisit your shaving technique or try a different hairstyle. Make sure to apply a soothing post-shave balm to calm skin.
  • Apply a warm compress. Do this two to three times daily. It can help soothe irritation and drain away the pus.
  • Use Antibacterial soap along the hairline, but not in your hair. If the problem is located mainly along the hairline, wash the area with antibacterial soap twice a day (antibacterial ointments like Neosporin can also be useful). Then use an oil-free or oil-control facial moisturizer. Check our article on [zelen blog link – the best natural and organic face moisturizers]
  • Use antidandruff shampoo in your hair. If the problem extends beyond the hairline onto the upper scalp, you don’t want to use soap. Instead, try the ketoconazole, ciclopirox, or tea tree oil shampoos. They kill bacteria and fungus, both of which could be contributing to the folliculitis.
  • Apply cortisone cream as a spot treatment. Only apply it directly to the lesions and inflamed areas. Cortisone cream works best at the hairline as hair can make it hard to apply to the scalp.
  • Wash all items that have come into contact with the affected part of your scalp, including hats, helmets, and other headgear.

If the issue persists, contact a dermatologist as you do not want to allow things to worsen.

They may prescribe therapies such as:

  • Topical antibiotics
  • Topical steroids
  • Oral antihistamines
  • Oral antibiotics
  • Oral isotretinoin

Once you have cleared up your folliculitis, you need to practice good scalp hygiene to keep the scalp clear and free of inflammation and blemishes. Make sure to rinse products thoroughly, and wash your hair often enough to keep it free of excess oil and impurities.

Scalp folliculitis prevention

Besides good scalp hygiene, there are a few other things you can do to prevent a reoccurrence. These are focused on reducing harm to the scalp, but as the damage is often very small, it can be hard to know that it is even happening.

Don’t wear tight-fitting hats, helmets, etc., they cause friction on the scalp and trap oils and impurities close to the follicles. Try to avoid headgear and opt for looser fitting options when you must wear them.

Do not play with your hair. Tugging or twirling your hair can damage the follicle and lead to folliculitis.

Do not scratch your head frequently, and if you have an itchy scalp, treat the cause to reduce the itch. If you must alleviate the sensation, try lightly massaging the scalp to get rid of the itch instead. Scratching causes tearing in the skin and gives bacteria and other infections a way to get past the skin’s natural barrier. If you are following these suggestions and still seeing reoccurrences, talk to a doctor to figure out what is leading to your folliculitis.

Those are the basics of scalp acne and folliculitis causes, treatments, and prevention. Let’s take a look at some other questions you might have about scalp acne.

Frequently asked questions (FAQ)

While doing our research for this article, we came across a few more common questions. We will address them below:

Can scalp acne or folliculitis cause hair loss?

Scalp acne is not directly related to hair loss. However, you are not doing yourself any favors by letting it linger. Acne involves infection and inflammation, which are not conducive to properly functioning follicles that grow healthy hair. If hair loss is a concern, you absolutely want to stay on top of scalp acne.

Scalp folliculitis, on the other hand, can lead to hair loss. Mild cases do not usually lead to hair loss, but they can turn into more severe cases, which often directly result in hair loss.

Can I pop the pimples on my scalp?

No, you should never pop your pimples or other blemishes. Leave this job to the experts as doing it anyway, but the correct one will push the infection deeper into the skin and lead to more significant problems.

This advice goes for any acne lesion anywhere on your body, do not pop them yourself unless you want to risk making things much worse.

If you pop your pimples, you risk:

  • Permanent scarring
  • More noticeable or severe acne
  • More painful blemishes
  • Infection

Does diet really affect acne?

Diet and acne are one of those areas in medicine where our understanding has increased in detail, and as a result, science has oscillated on whether diet is a risk factor for acne or not. At first, diet was believed to contribute to breakouts, and then several studies came out that seemed to disprove the link.

However, current research has refined that understanding. The reason for this back and forth is because the relationship between what we eat and breakouts was more complicated than previously thought. Diet is a potential factor in acne breakouts, but we have enriched our understanding of which types of foods can contribute to the formation of acne lesions.

Oily foods were once believed to lead to acne, but later this was dispelled as a myth. The truth is the type of fat matters. Healthy unsaturated fats don’t trigger breakouts, while the less healthy saturated fats do. Some fats, such as omega-3, can help to prevent breakouts in some people.

Carbohydrates are only triggers for breakouts if they fall high on the glycemic index (GI). That means they have high sugar to fiber ratios or carbs that quickly breakdown into sugars upon digestion. These are the type of foods that cause spikes in your blood sugar levels. Think of foods like white bread and sweets.[14]

Conclusion

Scalp acne and folliculitis are unpleasant and irritating conditions, but there are several therapies out there that can help to alleviate both of these conditions. With a little patience and perhaps the help of a dermatologist and their prescription pad, you can work your way back to a clearer, less irritated scalp.

If you have a mild or moderate acne case or folliculitis on your scalp, you can likely treat it at home. If the condition persists or you have a more severe case, you need to enlist the help of a dermatologist. There could be a more serious underlying cause or other adverse health consequences from letting either go untreated.

If you have struggled with scalp acne, which treatment you are excited to try first? If you have successfully battled this condition with a therapy not listed here, let us know in the comments so we can all learn more!

Finally, if you know someone who has scalp acne or folliculitis or who could benefit from this information, share this article with them.


References

  1. Sun, Kai-lv, and Jian-min Chang. “Special Types of Folliculitis Which Should Be Differentiated from Acne.” Dermato-Endocrinology 9, no. 1 (September 27, 2017). https://doi.org/10.1080/19381980.2017.1356519.
  2. Zander, E., and S. Weisman. “Treatment of Acne Vulgaris with Salicylic Acid Pads.” Clinical Therapeutics 14, no. 2 (April 1992): 247–53.
  3. Abels, Christoph, Alexandra Kaszuba, Iwonna Michalak, Dieter Werdier, Ulrich Knie, and Andrzej Kaszuba. “A 10% Glycolic Acid Containing Oil-in-Water Emulsion Improves Mild Acne: A Randomized Double-Blind Placebo-Controlled Trial.” Journal of Cosmetic Dermatology 10, no. 3 (2011): 202–9. https://doi.org/10.1111/j.1473-2165.2011.00572.x.
  4. Unno, Mizuki, Otomi Cho, and Takashi Sugita. “Inhibition of Propionibacterium Acnes Lipase Activity by the Antifungal Agent Ketoconazole.” Microbiology and Immunology 61, no. 1 (2017): 42–44. https://doi.org/10.1111/1348-0421.12464.
  5. Mazzarello, V, MG Donadu, M Ferrari, G Piga, D Usai, S Zanetti, and MA Sotgiu. “Treatment of Acne with a Combination of Propolis, Tea Tree Oil, and Aloe Vera Compared to Erythromycin Cream: Two Double-Blind Investigations.” Clinical Pharmacology : Advances and Applications 10 (December 13, 2018): 175–81. https://doi.org/10.2147/CPAA.S180474.
  6. Sandha, G K, and V K Swami. “JOJOBA OIL AS AN ORGANIC, SHELF STABLE STANDARD OILPHASE BASE FOR COSMETIC INDUSTRY,” 2009, 7.
  7. James, William D. “Acne.” New England Journal of Medicine 352, no. 14 (April 7, 2005): 1463–72. https://doi.org/10.1056/NEJMcp033487.
  8. “Hydrocortisone for Acne: Does It Work, Safety, and More,” April 24, 2020. https://www.medicalnewstoday.com/articles/hydrocortisone-for-acne.
  9. James, William D. “Acne.” New England Journal of Medicine 352, no. 14 (April 7, 2005): 1463–72. https://doi.org/10.1056/NEJMcp033487.
  10. Layton, Alison. “The Use of Isotretinoin in Acne.” Dermato-Endocrinology 1, no. 3 (May 1, 2009): 162–69. https://doi.org/10.4161/derm.1.3.9364.
  11. James, William D. “Acne.” New England Journal of Medicine 352, no. 14 (April 7, 2005): 1463–72. https://doi.org/10.1056/NEJMcp033487.
  12. Whitney, Kristen M, and Chérie M Ditre. “Management Strategies for Acne Vulgaris.” Clinical, Cosmetic and Investigational Dermatology 4 (April 26, 2011): 41–53. https://doi.org/10.2147/CCID.S10817.
  13. Mayo Clinic. “Acne Treatments: Medical Procedures May Help Clear Skin.” Accessed July 21, 2020. https://www.mayoclinic.org/diseases-conditions/acne/in-depth/acne-treatments/art-20045892.
  14. Whitney P. Bowe, Smita S. Joshi, and Alan R. Shalita, “Diet and Acne,” Journal of the American Academy of Dermatology 63, no. 1 (July 1, 2010): 124–41, https://doi.org/10.1016/j.jaad.2009.07.043.

About The Author

Dr. Shane Jackson MBBS
Dr. Shane Jackson MBBS

Dr. Jackson is a UK based NHS clinician with over 10 years experience in both hospital medicine and surgery. After an initial career in maxillofacial surgery his focus now lies in elderly care and rehabilitation medicine. A board member for Wadham College of Science, Dr. Jackson is passionate about widening access to both education and healthcare around the world and as a result, outside of his clinical work he spends much of his time either teaching or providing medical consultancy to healthcare startups. Commercially, his interests lie in helping research and promote novel, evidence-based medicines originating from natural sources and processes.

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