- Hairline acne is characterized by lesions that form along the hairline, temples and neck
- As with any acne, it develops when pores become clogged with oil and debris
- Oily, waxy or heavy hair styling and skin care products can all contribute to its development
- Hairline acne can be managed or eliminated by using noncomedogenic skin and hair care products and by changing some lifestyle habits
Hairline acne, like other forms of acne, develops due to the accumulation of excess oil, grime and dead skin cells resulting in blocked hair follicles. However, unlike other forms of acne, pimples on the hairline and temples are likely caused by the transfer of sebum and oily hair products from the scalp and hair.
Why Does Acne Appear Around the Hairline?
Acne can develop anywhere (except the soles of the feet and palms of the hands) but does so primarily where sebaceous glands are largest and most concentrated. These glands secrete sebum, a group of complex oils which play a key role in lubricating and balancing skin, and protecting against external environmental threats.
When sebum accumulates, it binds to dead skin cells and debris, resulting in clogged pores.
The hairline is particularly susceptible to acne because, along with the face and scalp region, this area has a high concentration of large, oil-secreting pores. This risk is further elated due to the presence of natural hair oils, hair styling products and sweat.
Blocked pores will either manifest as blackheads (open comedones) or whiteheads (closed comedones) which is indicative of noninflammatory acne; inflammatory acne will develop when Cutibacterium acnes bacteria accumulates and pus-filled papules and pustules form. These lesions cause redness and swelling.
Some Common Causes of Acne
Acne can develop on the body or along the hairline, temples and neck due to a number of causes including hormonal fluctuations, stress or a poor skin care regimen.
Hormonal fluctuations are strongly linked to acne flare-ups. This occurrence is very common during puberty for both males and females but also occurs at significant life stages for women such as pregnancy and menopause.
Androgen hormones play a key role in regulating sebum production, especially testosterone which triggers sebaceous gland activity. This results in acne developing on the face, hairline, back, neck and chest.
Stress impacts the skin negatively in a number of ways to cause stress acne.
During emotional distress, in what is termed the brain-skin connection, the brain releases corticotropin-releasing hormone (CRH) which travels in the bloodstream to the adrenal glands and triggers the release of cortisol, a stress hormone.
Adrenaline is also released, and both stimulate sebum production which increases the risk of oil buildup and blocked pores.
Stress can also cause an imbalance of bacteria in the gut which causes inflammation via the gut-skin connection. This inflammation can trigger or worsen skin conditions, including acne.
As well, science has established that there is a correlation between acne severity and the level of stress. One study of students during examinations demonstrated this link, with acne severity significantly associated with increased stress levels.
Stress also leads to behavioral changes that can aggravate symptoms, such as a lack of sleep which is a typical response to stress.
Skin care routine
Lack of a regular skin care routine or one that does not address your skin’s needs can contribute to acne development.
Furthermore, products containing alcohol or harsh ingredients can dry and irritate skin leading to an overproduction of sebum and clogged pores. Using comedogenic skin care products can clog pores, and failing to cleanse properly and exfoliate can cause product residue and dead skin cells to remain on the face and trigger acne breakouts.
Lastly, using products that are not compatible with your skin type can lead to a compromised skin barrier function which causes irritated, sensitive skin and leaves it susceptible to conditions such as acne.
Common Causes of Hairline Acne
When looking specifically at hairline acne, hair care products and headwear are implicated in its development.
How you wash your hair
If your hair tends to be oily, not washing it often enough can lead to clogged pores due to oil transferring to the skin along the hairline, temples and neck.
If shampoo is not thoroughly rinsed off, this increases the likelihood that shampoo residue will not only clog pores but will irritate skin. As well, this film will throw off your skin’s pH balance which also increases the risk of breakouts.
What you use on your hair
What you use on your hair can also cause acne due to chemicals that can cling to skin, causing sensitivity and irritation; and heavy oils that are comedogenic.
Shampoos and conditioners
Shampoos and conditioners contain a wide range of ingredients including surfactants such as sodium lauryl sulfate to rid hair of dirt and oils, emulsifiers to thicken or increase foaming and preservatives to prevent bacteria, yeast and mold from developing. Any one of these ingredients can irritate skin upon contact.
Hair products can also contain oils such as argon, coconut or jojoba oil. These substances can migrate from the scalp to the hairline and cause comedonal or inflammatory acne to develop. One study demonstrated that shampoo and conditioner residue can remain on the scalp, face and back for up to 2 hours.
Lastly, fragrances can cause irritation and damage skin, leaving it vulnerable to inflammation; oils and silicones can block pores and disrupt the skin’s pH.
Pomades, waxes and gels
Hair styling and moisturizing products contain chemicals such as petroleum and silicon, which create a thin coat that protects against frizziness and leaves hair shining. However these chemicals can also deposit a layer of oiliness along the hairline and cause lesions to form.
The viscosity of pomades can form a seal over pores near the hairline, as can rubbery waxes and sticky gels. Long-term use of thick and oily emollients can result in a type of hairline acne known as pomade acne.
Hairspray and dry shampoo
Both hairspray and dry shampoo contain a number of harmful chemicals that are known to dry and irritate skin. These include alcohol, liquid petroleum gas, butane, silicones and cetrimonium chloride, to name just a few.
In addition to causing pulmonary diseases, with repeated use, these chemicals can dry out and irritate skin, leaving it sensitive and at risk of acne breakouts.
As well, overuse of dry shampoo can leave a residue on the scalp and surrounding skin, which can cause irritation and inflammation and acne flare-ups.
Headbands, hats and headwear
Prolonged or repeated wearing of tight-fitting headwear can encourage the development of acne which occurs due to a combination of pressure, heat and friction.
When oil from both the scalp and hairline skin become trapped with dead skin cells, debris and bacteria it creates an ideal environment for acne to flourish. The warm environment combined with repeated friction from the headwear also contributes to aggravating skin and can prompt the development of both noninflammatory and inflammatory hairline acne.
The ongoing Covid-19 pandemic has also given rise to what is called maskne. As with headwear, masks have been identified as incubators of bacteria due to the tight-fitting cotton that prevents air circulation, causes friction and traps moisture, oils, heat and sweat. The result is acne breakouts not only on the face, but along the hairline due to the ear loops.
Treating Hairline Acne
Hairline acne can be effectively treated by changing some lifestyle habits, regular use of effective skin care products and topical solutions.
Avoid using comedogenic ingredients such as cocoa butter, coconut oil, hydrogenated castor oil and butyl stearate. When choosing any hair care products, opt for those that are identified as oil-free and noncomedogenic.
As well, look for products that are sulfate- silicone-, fragrance- and dye-free. The less irritating ingredients in your hair products, the less likely your skin will break out.
When washing your hair, ensure you thoroughly rinse off all products from your scalp and skin. Immediately after showering, rinse or wash your face and follow with an appropriate toner to remove any lingering product residue; lastly, apply a moisturizer to protect your skin.
Build an effective skin care routine
If mild hairline acne is left untreated, it can spread, worsen and degrade to inflammatory lesions.
You can prevent this from occurring by following a skin care regimen that suits your specific skin type. This would include a gentle face wash that is pH balanced and an exfoliating product to prevent oil and dead skin cells from building up on the surface of your skin.
Two appropriate exfoliating agents are glycolic acid and lactic acid; both are gentle on skin and effective in exfoliating the top layer of skin and clearing pores of debris.
Lastly, all products you purchase should be labeled as noncomedogenic to ensure they will not block pores.
Other steps you can take
Making a few changes to your routine can help reduce the likelihood of acne developing.
- Cleanse your face properly at the end of the day to ensure you are makeup-, grime- and sunscreen-free; follow with toner and moisturizer to maintain healthy skin
- Wash hair immediately after exercise to prevent sweat from accumulating in pores
- Keep hair away from your face and back of the neck to avoid transferring oils to your skin
- Regularly wash your bedsheets (especially pillowcases) headbands and hats to prevent transferring oils and bacteria to your skin
Topical over the counter treatments
In addition to improving habits to prevent acne, there are several OTC products formulated with specific active ingredients to treat acne symptoms.
Benzoyl peroxide is an agent that can kill acne-causing bacteria. As an antibacterial it is most effective against inflammatory symptoms but has also been shown to clear comedones by removing excess sebum and unblocking pores.
Topical retinoid treatments are considered a mainstay of acne therapy as they can successfully treat noninflammatory and inflammatory acne lesions. They can unclog pores, reduce sebum production and increase skin cell turnover.
Studies have shown that retinoids can significantly reduce inflammatory lesions.
Salicylic acid can loosen the bonds that bind dead skin cells together to slough off dead skin cells and debris to effectively clear pores of comedonal acne. This acid can also reduce inflammation and accompanying redness.
As part of combination therapy, salicylic acid is commonly used alongside other active ingredients such as benzoyl peroxide for greater results.
Home Remedies for Hairline Acne
As an alternative to OTC treatments, there are natural home remedies that can help treat acne. In particular, green tea and tea tree oil products have both demonstrated efficacy.
Tea tree oil
Hairline breakouts can be managed through the use of tea tree oil, an essential oil with antibacterial and anti-inflammatory properties. Studies have demonstrated that products containing this oil can significantly improve mild to moderate acne.
Tea tree oil must first be diluted with a carrier oil. To use, apply the diluted mixture with a cotton swab directly to the treatment area.
Green tea contains plant polyphenol compounds that are known for their anti-inflammatory effects. In one study review, researchers found these polyphenols were effective at either reducing sebum production or improving acne severity.
Green tea supplement capsules and polyphenol extracts are found in many health food stores.
Hairline acne could easily be confused with other skin conditions or diseases due to common dermatological symptoms such as red bumps and inflammation.
Folliculitis causes red, pimple-like bumps on the skin due to inflamed hair follicles. This common condition is usually caused by infection from Staphylococcus aureus bacteria but can also result from a fungal or viral infection.
Scalp acne, also known as scalp folliculitis is a fairly common condition and develops due to the same reasons as folliculitis. It typically develops along the hairline but can affect any part of the scalp.
Scalp acne manifests as small red bumps with pus-filled tips and scabs; accompanying sensations can include itching, stinging, burning and pain.
Measles is caused by a viral infection and is characterized by high fever, cough and runny nose and eyes. A rash, consisting of flat, red spots, typically develops along the hairline and then spreads all along the body to the feet.
Hairline acne is a common skin condition that is characterized by lesions that develop along the hairline, temples and neck. Like any other acne, it occurs due to the accumulation of oils, dead skin cells and debris which results in blackheads and whiteheads; or inflamed pustules and papules due to the overgrowth of bacteria.
What makes hairline acne stand apart from other forms is that it typically develops due to a transfer of oils from the hair and scalp as well as from irritating or heavy hair care products. Wearing tight fitting headwear and masks can worsen symptoms or trigger an acne outbreak as can poor lifestyle habits.
You can prevent hairline acne by improving some everyday habits and consistently following a skin care regimen that includes gentle but effective cleansing and exfoliating products to free your skin of acne-causing oils and debris.
There are several proven OTC acne treatments such as benzoyl peroxide, retinoids and salicylic acid that can treat existing lesions and reduce future breakouts. For a natural treatment, tea tree oil and green tea have both been shown to improve acne symptoms.
- Weston WL et al. (eds). Structure and Function of the Skin. Color Textbook of Pediatric Dermatology. Fourth ed. 2007. Available at: http://sciencedirect.com/science/article/pii/B9780323049092500047/
- Hoover E, Aslam S, Krishnamurthy K. Physiology, Sebaceous Glands. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 14, 2021. https://pubmed.ncbi.nlm.nih.gov/29762994/
- Bagatin E, Freitas THP, Rivitti-Machado MC, et al. Adult female acne: a guide to clinical practice [published correction appears in An Bras Dermatol. 2019 Mar-Apr;94(2):255. Machado MCR [corrected to Rivitti-Machado MC]]. An Bras Dermatol. 2019;94(1):62-75. doi:10.1590/abd1806-4841.20198203
- Elsaie ML. Hormonal treatment of acne vulgaris: an update. Clin Cosmet Investig Dermatol. 2016;9:241-248. Published 2016 Sep 2. doi:10.2147/CCID.S114830
- Ganceviciene R, Graziene V, Fimmel S, Zouboulis CC. Involvement of the corticotropin-releasing hormone system in the pathogenesis of acne vulgaris. Br J Dermatol. 2009;160(2):345-352. doi:10.1111/j.1365-2133.2008.08959.x
- Chiu A, Chon SY, Kimball AB. The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress. Arch Dermatol. 2003;139(7):897-900. doi:10.1001/archderm.139.7.897
- Kim EJ, Dimsdale JE. The effect of psychosocial stress on sleep: a review of polysomnographic evidence. Behav Sleep Med. 2007;5(4):256-278. doi:10.1080/15402000701557383
- Sinha S, Lin G, Ferenczi K. The skin microbiome and the gut-skin axis. Clin Dermatol. 2021;39(5):829-839. doi:10.1016/j.clindermatol.2021.08.021
- Rocha MA, Bagatin E. Skin barrier and microbiome in acne. Arch Dermatol Res. 2018;310(3):181-185. doi:10.1007/s00403-017-1795-3
- Rubin IK, Gourion-Arsiquaud S. Deposition and Retention of Hair Care Product Residue Over Time on Specific Skin Areas. J Drugs Dermatol. 2020;19(4):419-423. https://pubmed.ncbi.nlm.nih.gov/32272520/
- Oosterhaven JAF. Anatomical location differences in sodium lauryl sulfate-induced irritation. Br J Dermatol. 2019;181(1):19-20. doi:10.1111/bjd.18100
- Teo WL. The “Maskne” microbiome – pathophysiology and therapeutics. Int J Dermatol. 2021;60(7):799-809. doi:10.1111/ijd.15425
- Baek JH, Ahn HJ, Koh JS, Kwon H, Shin MK. Early detection of microcomedones induced by cocoa butter using reflectance confocal microscopy. J Cosmet Dermatol. 2022;21(7):3016-3021. doi:10.1111/jocd.14522
- Leyden J, Stein-Gold L, Weiss J. Why Topical Retinoids Are Mainstay of Therapy for Acne. Dermatol Ther (Heidelb). 2017;7(3):293-304. doi:10.1007/s13555-017-0185-2
- Millikan LE. The rationale for using a topical retinoid for inflammatory acne. Am J Clin Dermatol. 2003;4(2):75-80. doi:10.2165/00128071-200304020-00001
- Saric S, Notay M, Sivamani RK. Green Tea and Other Tea Polyphenols: Effects on Sebum Production and Acne Vulgaris. Antioxidants (Basel). 2016;6(1):2. Published 2016 Dec 29. doi:10.3390/antiox6010002
- Malhi HK, Tu J, Riley TV, Kumarasinghe SP, Hammer KA. Tea tree oil gel for mild to moderate acne; a 12 week uncontrolled, open-label phase II pilot study. Australas J Dermatol. 2017;58(3):205-210. doi:10.1111/ajd.12465
- Laureano AC, Schwartz RA, Cohen PJ. Facial bacterial infections: folliculitis. Clin Dermatol. 2014;32(6):711-714. doi:10.1016/j.clindermatol.2014.02.009
- Lugović-Mihić L, Barisić F, Bulat V, et al. Differential diagnosis of the scalp hair folliculitis. Acta Clin Croat. 2011;50(3):395-402. https://pubmed.ncbi.nlm.nih.gov/22384776/