One of the least comfortable places to get acne is on your scalp, but it's really no different from any other area of your body that may experience breakouts, right? Like your standard pimples, scalp acne can be caused by a mixture of oil and dead skin cells that get stuck in hair follicles. Unfortunately, the cause of scalp acne isn't always as straightforward as that. We talked to dermatologist Nava Greenfield, MD, of Schweiger Dermatology Group to get her take, and it turns out those blemishes can vary in what they even are, let alone what causes them.
We also chatted with Neal Schultz, MD, about how to suss out what are actually pimples on your scalp versus what are bumps caused by severe dandruff—which can cause pimple-like spots on your scalp.
Meet the Expert
Nava Greenfield is a medical dermatologist at Schweiger Dermatology Group in NYC. Her work has led to contributions in publications such as The Journal of Dermatological Treatment.
Neal Schultz is a New York City dermatologist with more than 30 years of experience. He's also the developer of the brand Beauty Rx, a skincare line developed to give dermatologist office results at home.
What Causes Scalp Acne?
Greenfield explains, "Blemishes on the scalp can be caused by a wide range of skin disease, some of which are very benign and others that are more serious. The most common blemishes on the scalp that I see are from cysts on the scalp, scalp acne, and from seborrheic dermatitis, or dandruff." Luckily, the treatments that go along with these types of scalp blemishes are simple. Greenfield says, "These conditions are easily treatable with either a simple excision (for a cyst) or anti-dandruff and anti-acne medications."
Things like travel, stress, and lack of sleep can also cause scalp acne, Schultz adds. When your cortisol levels rise, your body is more likely to produce oil. This excess oil can cause acne.
If you're finding frequent breakouts on your scalp, there's a singular wise method of treatment, as Greenfield puts it: "Bottom line: check with your dermatologist!" "A dermatologist can help you categorize the types of breakouts you're seeing and figure out the best treatment," Greenfield explains. "It's important to have a dermatologist evaluate any blemishes because other more serious diseases, like cutaneous lupus and lichen planopilaris, can also result in spots on the scalp. These can be treated as well, but require closer attention by your dermatologist."
How to Prevent Scalp Acne
When it comes to preventing pimples on your scalp, the same rules apply here as your face, namely keeping your hands off. Picking and prodding at blemishes will only make them more numerous. Additionally, as with any other area of acne, scalp breakouts can potentially be hormonal. In that case, a visit to the dermatologist, as per Greenfield's suggestion, is best.
However, if you are prone to oily hair, it could be an excess of oil. You'll want to be sure you're washing with water every other day, even if you skip the shampoo—especially after workouts. Schultz agrees that washing your hair to prevent excess oil is super important. Look for shampoos with ingredients like salicylic acid, coal tar, or cortisone. Salicylic acid and coal tar are meant to help reduce dandruff and oil production on your scalp, while cortisone helps treat inflammation and dryness. A shampoo with cortisone is normally only available in the doctor's office, so be sure to check with your dermatologist.
The good news about washing your hair more frequently? "There's no such thing as over-washing your hair," Schultz says, however, this may not apply to those with natural, coily hair. If you prefer your regular shampoo because it's volumizing or makes your hair silky soft, feel free to go in for a second shampoo after using an acne-formulated shampoo.
If you must touch a pimple on your scalp, avoid picking and scratching at it as much as possible. Popping or scratching the spot can allow bacteria to enter it, delaying healing time and further irritating it.
Even with dandruff, you can get a rash that looks like pimples. Even though they aren't technically acne, they can still itch like crazy. "They get even crustier when you pick at them, which everybody does," Dr. Schultz says. Basically, the same rule for pimples go for this rash, too: try to keep your hands off!
If the pimple is super itchy, try gently pressing on it instead. Adding some pressure can help take away the itch, plus it doesn't open up the pimple.
Remember to Exfoliate
An exfoliating scalp treatment once a week can also help clear your scalp of any excess dry skin. Tea-tree oil can also be used to treat acne as you would on your face by adding a drop to your shampoo—but a little goes a long way here. Too much oil may make your acne worse—more on that later.
Although exfoliating helps remove excess oil and dry skin, it's better to stick to chemical exfoliants (like salicylic or glycolic acid) than physical exfoliants. "The problem on the scalp is already irritation, and I'm afraid that a physical exfoliator is going to cause too much irritation," Schultz says.
If you feel you must use a physical exfoliant, stick to something gentle and only use it when your scalp isn't seriously irritated.
Avoid Adding Oils
Avoid using thick or greasy hair products that will leave a film behind. Keep hair repair treatments and deep conditioning masks away from the scalp. Instead, use them to treat damaged ends as these can lend an excess of oil to the roots—the same goes for your everyday conditioner.
Many people with acne or severe dandruff suffer from an excess of oil on the scalp. Even though oils are great for moisturizing your hair, they can cause buildup on your scalp and actually make your acne worse: "You don't want to feed fuel to the fire; you don't want to put oil on acne," Schultz says.
Don't Be Afraid to Use Acne Products
You can treat mild scalp acne with most any over-the-counter acne product on the market, although you may want to avoid products containing benzoyl peroxide because they can lead to bleaching or discoloration of hair. A light moisturizer containing salicylic acid is a good option for small spots on your scalp, and it won't bleach your hair either. But, if your acne continues or gets really severe, consider talking to a dermatologist about an oral or topical medication that might work better for you.
Up next, read one psychologist's take on the best way to stop picking at blemishes.
Zari S, Alrahmani D. The association between stress and acne among female medical students in Jeddah, Saudi Arabia. Clin Cosmet Investig Dermatol. 2017;10:503-506. doi:10.2147/CCID.S148499