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Scalp Acne

What It Is and How to Treat It

By: Dan Kern, Acne.org Founder & CSO
Last updated: July 27, 2020

The Essential Information

Acne can occur on the scalp, but is less noticeable because hair covers it up. Hair, however, can make it harder to treat as well.

If you only get an occasional pimple on your scalp, don't worry about it. Leave it be and it should clear on its own.

However, if you experience more than an occasional pimple on your scalp, here are a couple of ways to help prevent scalp acne:

  1. Avoid greasy hairstyling products, especially pomades and brilliantine.
  2. Stop using conditioner for a while and only use shampoo and see if this helps.
     

Treatment options for scalp acne are similar for acne anywhere on the face or body, with the addition of dandruff shampoo:

  • Benzoyl peroxide - Benzoyl peroxide is powerful at reducing acne, but since it is a peroxide, it may lighten some people's hair. It doesn't dramatically bleach the hair, but it can noticeably lighten it. 
  • Salicylic acid - Salicylic acid is not as strong or effective as benzoyl peroxide, but will not lighten the hair. 
  • Dandruff shampoo - Dandruff shampoo contains antifungal ingredients like ketoconazole or ciclopirox, and some people claim it helps reduce scalp acne, but there are no studies to confirm this. 

The Science

Acne can occur on the scalp much like it can on the face and on the rest of the body. However, the scalp can be harder to treat because the hair gets in the way.

The good news is that scalp acne is often much less noticeable because hair covers it up. Many people get occasional pimples on the scalp and simply let them be. While acne lesions on the scalp can tend to be tender and sore, they usually clear on their own within a week or so. However, if you suffer with scalp acne that is really bugging you, read on.

Scalp Acne

What to Avoid

Oily or greasy styling products: Styling products sometimes contain oils or other irritating ingredients that can aggravate acne. If you're battling with some scalp acne, try forgoing your usual styling products for a few weeks and see if that helps clear you up. This is particularly true of some hair products marketed to black people that can contain greasy emollients. Pomade, for instance, is so well known for causing acne that it has it's own nickname in the dermatological community: "pomade acne."1

Hair conditioner: Some hair conditioners also contain heavy humectants which can irritate acne-prone skin. If you're struggling with scalp acne, try using only a gentle shampoo for your hair and not using conditioner for a few weeks and see if that helps.

Comedogenic (pore-clogging) ingredients: Check the label of your hair products to make sure they do not contain comedogenic ingredients

Heavily fragranced products: The skin of a small percentage of people is sensitive to fragrances. Ingredients that impart fragrance can sometimes irritate the skin of sensitive people, and this irritation may lead to more acne. 

Styling Products and Scalp Acne

What to Avoid - Scalp Acne

Treatment Options

You can treat acne on the scalp with many of the medications used to treat acne on the rest of the face and body. The most effective medication is benzoyl peroxide, however it is a peroxide, which means it can lighten hair in some people.

Salicylic acid is another widely available over-the-counter ingredient that can be easily be applied to the scalp with the fingers or with a cotton ball, but usually only provides partial effectiveness.

People on the acne.org forums have also been experimenting with dandruff shampoo to treat their body acne, so shampooing with a dandruff shampoo might be an interesting option for the scalp as well. Anti-fungal ingredients in dandruff shampoo such as ketoconazole or ciclopirox may also be able to help with scalp folliculitis (see below).

A Rare Special Case: Acne Keloidalis Nuchae That Extends to the Scalp

Sometimes, a special form of acne known as acne keloidalis nuchae (AKN), which usually occurs on the back of the neck, can extend to the scalp on the back of the head. AKN is most common in African-American males and is often triggered by physical irritation of the back of the neck, such as from closely shaving the hair on the back of the neck. In certain rare cases, AKN can lead to alopecia (hair loss).2-4 If you suspect you might have AKN, ask your barber to be extra gentle when clipping your hair, and ask that he/she doesn't get too close to the skin. Generally speaking, ask them to be careful when working around the back of your neck.

Scalp Folliculitis

Scalp folliculitis is a hair follicle disorder which can result in widespread, itchy breakouts, often along the hairline. It is thought to be caused by bacteria and yeasts.5If you think you have folliculitis, see your doctor for prescription therapy. Therapy for scalp folliculitis may include antibiotic, antifungal, antihistamine, and/or steroidal agents.

Scalp Folliculitis

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References:

  1. Davis, E. C. & Callender, V. D. A review of acne in ethnic skin: pathogenesis, clinical manifestations, and management strategies. J. Clin. Aesthet. Dermatol. 3, 24-38 (2010). https://www.ncbi.nlm.nih.gov/pubmed/20725545
  2. Al Aboud, D. M. & Badri, T. Acne Keloidalis Nuchae. [Updated 2020 Jan 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459135/
  3. Maranda, E.L., Simmons, B.J., Nguyen, A.H. et al. Treatment of acne keloidalis nuchae: A systematic review of the literature. Dermatol. Ther. (Heidelb.) 6, 363 - 378 (2016). https://www.ncbi.nlm.nih.gov/pubmed/27432170
  4. Sun, K. L. & Chang, J. M. Special types of folliculitis which should be differentiated from acne. Dermatoendocrinol. 9, e1356519 (2017). https://www.ncbi.nlm.nih.gov/pubmed/29484091
  5. Oakley, Amanda. Scalp folliculitis. https://www.dermnetnz.org/acne/scalp-folliculitis.html

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