Scalp Acne: Causes, Treatments, Best Shampoos and More

• Scalp acne develops for the same reasons as elsewhere on the body, along with product buildup and infrequent hair washing.
• This condition is addressed with medicated shampoos and topical treatments.
• More severe or cystic scalp acne can be treated with prescription medication.
• Develop good hygiene hair habits to prevent scalp acne from occurring.

Acne can develop anywhere on the body, including the scalp. It occurs when dead skin cells, dirt and bacteria become trapped inside pores or hair follicles. These clogged pores and oil from the sebaceous glands then become inflamed and enlarged. Scalp acne can be treated with specific products and medications designed for specific use in this area; often, it can be prevented with lifestyle changes.

Scalp Acne Symptoms

Scalp acne typically appears along the hairline in the form of small, sometimes itchy pimples. In more advanced forms, it can include papules, pustules, nodules and cysts. Severe scalp acne can form black crusts and cause permanent scarring.

Scalp acne can be mistaken for other common skin conditions that develop on the scalp:

• Scalp folliculitis is a condition similar to acne in which bacteria cause hair follicles to become inflamed, resulting in small, itchy, red bumps
• Seborrheic dermatitis causes redness, white or yellow scaly patches, and dandruff
• Pilar cysts are hard, flesh-colored bumps that form around hair follicles on the scalp; while they are harmless, some people have them removed for cosmetic reasons. 

Does scalp acne cause hair loss?

Scalp acne does not necessarily lead to hair loss. However, picking at pimples on your scalp can cause infections and scarring, which can cause hair loss and bald patches. If you experience painful, chronic acne on the scalp, consult a doctor or dermatologist to develop a treatment plan that will minimize permanent damage.

What Causes Pimples on the Scalp?

Acne develops on the scalp for the same reasons as elsewhere on the body, including due to hormonal changes, excess oiliness, diet, stress, genetics and poor hygiene. The inflammation resulting from scalp acne is caused by the proliferation of Propionibacterium acnes or Staphylococcus epidermidis, both being bacteria normally present on the skin. It can also be due to fungus or mites.

Other reasons for pimples on the scalp include the buildup of products such as dry shampoo, hair gel or hair spray; infrequent hair washing, especially after exercise; and wearing headgear that irritates the scalp.

Best Medicated Shampoos for Scalp Acne

Medicated shampoo is the most common treatment for scalp acne. These shampoos cleanse the hair and scalp while delivering active ingredients to exfoliate, reduce sebum and kill the bacteria or fungus that cause flare-ups. 

Medicated shampoos are available over the counter (OTC) at pharmacies. To effectively treat your scalp, follow all directions included with the product; most are designed to be used twice a week.

Once your breakout clears up, you can continue using the product to prevent the acne from recurring.

Salicylic acid 

Salicylic acid treats pimples on the scalp in several ways. It is an anti-inflammatory that exfoliates dead skin cells to prevent new blemishes from forming, and it reduces oil production. Look for products containing 3% salicylic acid. Do not use it more often than directed, as this ingredient can dry out your hair and skin.

Glycolic acid 

Glycolic acid effectively treats acne by exfoliating skin and killing bacteria. Most shampoo brands do not list the percentage of glycolic acid they contain, but those that do generally contain a high percentage – up to 10%.

Tea tree oil 

Shampoos formulated with tea tree oil dry up excess oil and fight acne-causing bacteria. Choose a product that does not contain other oils such as coconut oil, as they may clog your pores and cause further breakouts.

Ketoconazole 

Although typically marketed as a dandruff shampoo, this shampoo may help reduce acne caused by fungal infections. They are available OTC at 1% strength and at 2% or more by prescription.

Best Treatments for Persistent Scalp Acne

Chronic or recurrent scalp acne that does not respond to medicated shampoos can be treated with OTC topical treatments or, in severe cases, injections and oral medications prescribed by a doctor or dermatologist.

Over-the-counter topical creams

Creams, gels and serums can all be used to manage scalp acne. Look for products containing anti-acne active ingredients such as salicylic or glycolic acid, or tea tree oil.

Retinoid creams have also been proven effective at reducing and preventing the formation of microcomedones, the precursors of other types of acne, and bringing down inflammation.

To safely apply topical creams to the scalp, follow all directions included with your product.

Steroid injections or creams

Your provider may prescribe topical steroid creams to reduce the inflammation and swelling associated with acne. However, as these medications only address the symptoms of acne and not the cause, you will likely use this alongside other therapies.

For severe scalp acne, steroids can be injected directly into individual cysts to reduce pain and swelling, and facilitate the healing process.

Oral medications

Acne in adult women is often a result of hormonal fluctuations. When this is the case, combined oral contraceptives are an effective treatment. Oral antibiotics are often temporarily prescribed in conjunction with other medications to reduce infection in the scalp.

For severe acne, the oral retinoid isotretinoin is prescribed for short periods of time to reduce sebum production.

How to Prevent Scalp Acne

For some people, a few basic preventative measures are sufficient to prevent scalp acne from recurring; for others, these habits can reduce its severity. They involve small lifestyle changes and careful selection of hair products.

Avoid popping pimples on the scalp

Do not pop or pick at pimples on the scalp. Your fingers can push bacteria deeper into your pores while introducing more bacteria to the area, increasing inflammation and the risk of scarring.       

Use the correct shampoo 

Using shampoo or conditioner designed for oily hair on a dry scalp or vice versa may disrupt sebum levels in the skin of your scalp and cause acne. 

Gently wash your scalp on a regular basis with a shampoo that’s suitable for your hair type to reduce the likelihood of developing pimples.

Use noncomedogenic hair products

Certain waxes, clays and hair sprays contain ingredients that are comedogenic, meaning they clog pores. Choose hair products with only noncomedogenic ingredients to prevent scalp acne due to product use.

Avoid benzoyl peroxide

Although benzoyl peroxide is commonly recommended as an acne treatment for the face, avoid using it on the scalp; it has bleaching properties that may cause unwanted lightening of your hair.

Wash bedding regularly

Launder your sheets and pillowcases once a week to prevent the buildup of dead skin cells and bacteria that can cause acne upon contact with your skin.

Takeaway

Scalp acne is caused by excess sebum production, diet, genetics, product buildup and poor hair care habits. It can be treated with salicylic or glycolic acid, and tea tree oil in the form of medicated shampoos or topical scalp treatments. Antifungal, antidandruff shampoos that contain ketoconazole may also effectively reduce infection and inflammation of the scalp.

If you find you cannot manage your scalp acne with OTC products alone, a doctor can prescribe topical or oral medications such as steroid creams, antibiotics or isotretinoin.

Prevent scalp acne by regularly washing your hair with a shampoo designed for your hair type and choosing noncomedogenic hair products. Do not pop or pick at scalp pimples, and launder your bedding once a week to prevent the spread of acne-causing bacteria.