How to treat and prevent scalp acne
American Family Physician: “Diagnosis and Treatment of Acne.”
What to Know About Scalp Acne
Scalp pimples are very common, but making a few adjustments to your hair routine can usually clear it up.
What Causes Scalp Pimples?
Scalp acne is when pimples and breakouts happen on your scalp or hairline. Acne can be a complex skin condition, but it generally happens because of four processes:
- An increase of sebum, or oil, production
- A buildup of dead skin cells and dirt in your hair follicle
- Inflammation in the blocked hair follicle
- An increase in acne bacteria
Your scalp is full of hair follicles and oil glands. If the follicle or pore becomes clogged with dirt and oil, this can lead to acne. You can still get scalp acne even if you have good hygiene, but sweat, oil, and dirt buildup from improper or incomplete washing can lead to clogged pores.
However, you may need to reexamine your hair care routine. Lots of scalp pimples are caused by shampoo, styling gel, and hairsprays that leave residues on your scalp and also clog your pores.
Scalp acne caused by hair products is so common that it has its own medical name: acne cosmetica.
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Hormones can also cause acne. Androgen hormones, especially testosterone, cause your body to make more oil. The increase of hormones during puberty is often responsible for acne, but adults can have hormonal acne too.
Genetics will affect your skin. If you have an immediate family member who has acne, you’re more likely to have it too.
Types of Scalp Acne
Acne is usually graded by severity and by the type of pimples you have, which might change your treatment.
Types of acne severity include:
Types of pimples include:
- Blackheads, called open comedones
- Whiteheads, called closed comedones
- Papules, or inflamed bumps
- Pustules, or bumps filled with pus
- Nodules or cysts, which are painful pimples deep in your skin
- Mixed, which is a combination of types
Sometimes you can get severe forms of acne that can affect your scalp called acne conglobata and acne fulminans. These are very uncommon.
Symptoms of Scalp Acne
Scalp acne can appear throughout your hair or along your hairline. Common symptoms include:
- Tiny bumps along your forehead or the back of your neck.
- Tiny bumps you can feel but can’t see.
- Tiny bumps packed together that you can see.
- Whiteheads on your scalp or hairline.
- Flesh-colored bumps on your scalp or hairline.
- Painful bumps on your scalp.
- Deep cysts under your skin with no head.
- Itchiness
Sometimes acne affects your emotions and self-esteem. It’s common for people to feel embarrassed and even depressed because of acne.
Scalp Acne Treatment
If your scalp acne is caused by your shampoo or other cosmetics, it will go away on its own when you stop using them. It can take up to 6 weeks to see improvement, but the first thing to do is to change your hair routine and products.
Switch to shampoo, conditioner, hair spray, and products that don’t contain oil. The label should say things like:
- Oil free
- Non-comedogenic
- Anti-acnegenic
- Won’t clog pores
Keeping the dirt, oil, and sweat off your scalp will help keep your pores clean. You might need to wash your hair more often, especially if you:
- Have oily hair
- Use a lot of products in your hair
- Sweat a lot in the day
- Have dirt or grime in your hair from the day
To wash your hair, focus on the scalp. The hair on your head is dead, and while your hair products can help keep your hair shiny and healthy-looking, it’s actually more important to wash dirt and oil from your scalp.
It’s also important to make sure you fully rinse all the extra shampoo and conditioner off your scalp and face. The pimples along your hairline might be caused by buildup from improper rinsing.
The product residue can also transfer to whatever touches your hair, which can add to the problem. Make sure to wash everything that touches your head, including:
- Pillowcases
- Hats
- Visors
- Headscarfs
- Headbands
- Bedsheets
- Blankets
Scalp Acne Shampoo
If thorough rinsing doesn’t help, you may be able to manage scalp acne by changing to products that are oil-free and antibacterial. Also look for:
- Anti-dandruff shampoo that contains selenium sulfide or zinc pyrithione
- Antifungal shampoo that contains ciclopirox or ketoconazole
- Salicylic acid shampoo
- Sulfur shampoo
Other Treatments for Scalp Acne
If topical remedies don’t ease your scalp acne symptoms, you might need other treatments. These can include:
- Antibiotics
- Photodynamic therapy
- Drainage for complicated cystic scalp acne
Outlook for Scalp Acne
Lots of times scalp pimples are from shampoo or other products. Just making a switch to your hair routine can get rid of the problem without any other treatment. Other times, scalp acne is a bit more complicated and needs other treatment. The outlook for scalp acne is good, but if it doesn’t get better with some of these changes, talk to your doctor.
Scalp Acne vs. Folliculitis Decalvans
A condition that can look similar to scalp acne is folliculitis decalvans. It’s a rare form of alopecia or hair loss. Scientists aren’t sure exactly what causes it, but they think it may be an abnormal response by the body to the bacterium Staphylococcus aureus.
Folliculitis decalvans usually begins in adulthood. The primary symptoms are patchy hair loss with inflammation, and pimple-like sores around the area where hair falls out. It usually affects the skin on your scalp, most often on the back of the head. You’ll notice irritated spots with sores or pimple-like bumps on them. You may have discomfort in the affected areas. The affected hair will fall out, leaving round or oval-shaped bald patches.
Major symptoms of folliculitis decalvans include:
- Patches of hair loss
- Clusters of pustules around bald patches
- Several hairs growing out of a single follicle, causing a tufted appearance like the bristles on a toothbrush
- Redness or swelling of the scalp
There is no cure for folliculitis decalvans, but some treatments can relieve symptoms. They may include:
- Oral antibiotics to clear up any sores or pustules that are on your scalp
- Topical antibiotics that can reduce the presence of staphylococcus aureus
- Isotretinoin to treat pustules
- Oral or topical corticosteroids to reduce inflammation, pain, and itching
- Photodynamic therapy to reduce the severity of symptoms
Show Sources
American Academy of Dermatology Association: “10 reasons your scalp itches and how to get relief,” “Acne: Overview,” “Are your hair care products causing breakouts?” “Tips for healthy hair,” “What kids should know about taking care of your hair.”
American Family Physician: “Diagnosis and Treatment of Acne.”
Indian Journal of Dermatology: “Shampoo and Conditioners: What a Dermatologist Should Know?”
International Journal of Trichology: “Acne Conglobata of the Scalp.”
Medscape: “Acne Fulminans.”
Molecules: “Treatment Modalities for Acne.”
Photodiagnosis and Photodynamic Therapy: “Combination of surgery and photodynamic therapy for the treatment of cystic acne of the scalp.”
Cleveland Clinic: “Scalp Pimples and Acne.”
Klein, K. and Palefsky, I: Handbook for Cleaning/Decontamination of Surfaces, 2007.
DermNet: “What causes folliculitis decalvans?”
Photo credit: Lukasz Szczepanski/Dreamstime
How to treat and prevent scalp acne
Acne is less common on the scalp than on other areas of the body. However, pimples on the scalp can be just as troublesome.
Clogged pores often cause pimples on the scalp or scalp acne. Keeping the hair and scalp clean and using medicated shampoos can help treat the condition.
This article looks at how a person can identify scalp acne, what causes scalp acne to develop, and discusses the ways a person can treat and prevent this condition.
Scalp acne refers to the pimples and breakouts that develop on the scalp or hairline.
Scalp acne can develop when hair follicles become clogged by a buildup of dead skin cells or excess sebum, which can lead to inflammation in the hair follicle. Sebum is the natural oil produced by sebaceous glands to form a protective barrier on the skin.
A person’s pores can also get clogged if they do not wash their hair frequently or they regularly wear headgear that causes friction against the scalp.
The American Academy of Dermatology Association (AAD) notes that some people may develop bumps or pimples on their scalp when using certain shampoos, conditioners, or hairsprays.
This particular type of breakout is called acne cosmetica, which refers to scalp acne that develops upon using products that come into contact with the hair or skin.
Furthermore, organisms that can lead to inflammation include :
- fungus
- mites
- Staphylococcus epidermidis
- Propionibacterium acnes
A person may need a topical, medicated treatment for their scalp acne.
Medicated topical products for scalp acne can be bought without a prescription. Common ingredients in these products may include:
- Salicylic acid: This is a common ingredient used in skin care products to fight acne. Salicylic acid helps to clear dead skin cells by breaking down the bonds between them.
- Glycolic acid: This acid can help exfoliate the scalp and remove dead skin cells, bacteria, and sebum.
- Ketoconazole: An antifungal agent, ketoconazole is used to treat red or scaly skin.
- Ciclopirox: Ciclopirox is an antifungal agent used to treat skin infections and is often added to dandruff shampoos
- Benzoyl peroxide: An antibacterial ingredient, benzoyl peroxide helps to eliminate the bacteria Propionibacterium acnes, which can be present in scalp acne.
For persistent scalp acne and symptoms such as hair loss and inflammation, a person can consider discussing the following treatments with a doctor:
- topical antibiotic ointments
- steroid injections
- oral antibiotics
- antihistamines for allergic reactions
- phototherapy, also called light therapy
- specific medications for severe acne, such as isotretinoin
A person with scalp acne should only use one type of scalp treatment at a time unless otherwise directed by a doctor. In doing this, it will be easier for a person to track the effectiveness of individual products against their scalp acne.
Scalp acne can vary in its appearance. Sometimes, scalp acne can resemble small pimples or zits on the scalp. These spots can develop on the back of the head and may feel itchy and sore.
In other cases, a person may develop pimples along their hairline or have painful bumps or cysts under the skin.
Pimples on the scalp occur when a pore or hair follicle gets clogged with dead skin cells or sebum.
Bacteria, yeast, or mites can also get into the pores and cause a reaction.
Factors that can cause scalp acne include:
- dead skin cells or oil clogging the follicles
- a buildup of products, such as hair gels, leave-in treatments, or hairspray
- not washing the hair thoroughly enough
- waiting too long after a workout to wash the hair
- sweating while wearing a head covering, especially if it causes friction
Specific germs that may cause pimples on the scalp include:
- Yeasts from the Malassezia family
- Cutibacterium
- Staphylococcus epidermidis
- Propionibacterium acnes
- Staphylococcus aureus
- Demodex folliculorum
A person’s diet may also be linked to acne. A study published in Advances in Dermatology and Allergology suggests that a diet high in sugary carbohydrates may increase the risk of acne.
The AAD states that people with scalp acne may notice that they have:
- tiny bumps along the hairline, on the forehead, or at the back of the neck
- whiteheads on the scalp or hairline
- closely packed bumps
- bumps on the scalp that are painful
Some people may also develop bumps that they can feel but are unable to see.
Scalp hygiene plays an essential role in avoiding clogged pores. A person can try washing their hair whenever it starts to feel oily and after every workout.
To treat scalp acne and prevent further flare-ups, a person can consider:
- wearing looser-fitting headgear to let the scalp breathe
- washing hair soon after exercise
- avoiding using too many hair products, such as hairsprays and gels
- eating a diet that can help boost skin health
- keeping a food diary to see if certain foods cause flare-ups if a person thinks their diet may be causing scalp acne
- switching to natural, hypoallergenic hair care products.
For some people, washing their hair infrequently can cause scalp acne. For other people, washing their hair too often can strip the skin of protective sebum, which may increase the risk of scalp irritation.
A person may wish to speak with a dermatologist to find out the best hair care routine for their skin.
People can develop pimples on the scalp, which, according to a 2019 article , can be:
- Mild: This usually includes whiteheads and blackheads, which are clogged pores in the skin.
- Moderate: Individuals with moderate scalp acne may have a higher number of inflamed pimples, called papules, that are visible on the skin’s surface. A person may also have pustules, which are filled with pus.
- Severe: A person with severe acne will have more papules and pustules, and the scalp can develop nodules and cysts, which can be painful.
There are a number of reasons why bumps and pimples might appear on the scalp, which can make it more difficult to identify scalp acne. These reasons can include:
- Scalp folliculitis:Scalp folliculitis is a related condition where bacteria, yeast infections, or ingrown hairs on the scalp cause the hair follicles to become infected and inflamed. This can result in itchy red bumps that can vary in size.
- Seborrheic dermatitis:Seborrheic dermatitis is a common condition that causes dandruff and often leaves the scalp red and scaly. Picking at the area can cause additional injury, leading to marks that resemble pimples.
- Pilar cysts:Pilar cysts are hard bumps filled with keratin that form near the hair root. Unlike scalp acne, these bumps usually do not have a white head.
In other cases, bumps on the scalp may be a sign of cancerous cells, such as squamous cell carcinoma.
A person should consider seeing a doctor if they think they have pimples on their scalp. A person may also consider seeking medical advice if they notice any signs of infection in any of their scalp pimples, such as pain, inflammation, or pus.
A person may wish to make a note of any hair products they are using in case they might be the cause of their scalp acne.
The AAD states that when a person’s scalp acne is caused by skin or hair care products, the scalp acne can go away on its own after the individual stops using the products.
Pimples on the scalp are relatively common and are treated in a similar way to acne on other parts of the body.
When treating scalp acne, a dermatologist will often recommend topical medications, which may include daily medicated shampoos.
A person can try taking preventive measures to improve their scalp acne, such as changing their hair care products or increasing or decreasing the amount they wash their hair overall.
Scalp acne may sometimes be a sign of more serious conditions. If a person finds their scalp acne is not responding to treatment, they may wish to consult with a doctor to seek other treatments or diagnoses.
Last medically reviewed on May 3, 2022
How we reviewed this article:
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