As if dealing with acne on your face and bumps on your body isn't annoying enough, finding pimples on your scalp can be stressful, too. Not only are they an unexpected issue to have to deal with, but scalp acne can be frustrating to treat, considering it's difficult to spot them and you can't use your favorite acne spot treatment in your hair. We asked the experts for their best tips and tricks for spotting, treating, and preventing scalp acne.
What Is Scalp Acne?
Acne on the scalp is similar to acne on the face. "Clogged pores can occur on the scalp and often do, as this area tends to be densely populated with sebaceous or oily glands," explains Blair Murphy-Rose, MD, FAAD, a board-certified dermatologist in New York City. "Pimples form on the scalp when a pore is clogged and bacteria is trapped, leading to inflammation."
Scalp acne is usually located on the scalp and back of the head, and manifests as small pimples that are very similar to those that we can find on our face. "Scalp acne is mainly caused by a buildup of product, dead skin cells, and oil that clogs hair follicles," says Dendy Engelman, MD, FACSM, FAAD, a board-certified dermatologist in New York City.
Treatment
Luckily, there are multiple ways you can treat scalp acne when it surfaces. To treat it, Engelman recommends using a clarifying shampoo at least once a week (she loves Moroccanoil Clarifying Shampoo, $26; amazon.com) to eliminate acne-causing bacterial growth. "I also recommend looking for products with tea tree oil; it can help moisturize your scalp, regulate bacteria, and break down buildup," says Engelman. She recommends Paul Mitchell Tea Tree Tingle & Treat Scalp Indulgence Set ($32; amazon.com), which features the Regeniplex™ botanical blend. It contains clover flower extract, pea peptides, turmeric, Kakadu plum, and ginseng to stimulate the scalp and protect against breakage.
Both Engelman and Murphy-Rose are fans of using salicylic acid to treat and prevent scalp acne. "Washing hair and scalp frequently will help to prevent acne, and using salicylic acid and antimicrobial can target underlying causes of acne of the scalp," says Murphy-Rose. "Salicylic acid helps to exfoliate the scalp and keep pores clean, while antibacterial ingredients reduce the bacteria load on the scalp."
Other ingredients Murphy-Rose recommends her patients look for when finding products to target scalp acne include activated charcoal to help "detox" the scalp by absorbing excess oils and sebum, as well as products with apple cider vinegar. She loves Better Not Younger New Dawn Activated Charcoal Scalp Cleanser ($35; better-notyounger.com), which provides a deep cleanse for the scalp with activated charcoal that absorbs oils and helps clear pores, as well as Ouai Detox Shampoo ($30; sephora.com) to help clarify the scalp and remove pore-clogging debris with apple cider vinegar.
If you have severe scalp acne, Engelman recommends using products that contain benzoyl peroxide or going to your dermatologist for an injection of cortisone.
What Shouldn't You Do if You Develop Scalp Acne?
You never want to pick at your scalp acne—it may be tempting, but it will only make the problem worse. "Avoid any products that add too much oil to your scalp/hair (including oily conditioners or sprays) and ingredients that are hard to wash out," says Engleman. "Dimethicone, for example, creates a barrier that can trap bacteria and dead skin cells in pores when not washed out properly."
You also want to let your scalp breathe if you're dealing with scalp acne frequently. "Stay away from tight hats like beanies and baseball caps that trap in heat. When the scalp is constricted, it causes sweat and bacteria to arise, causing acne to worsen and breakouts to occur," explains Engleman.
Prevention
The best way to prevent scalp acne is to be conscious of your hair care routine. "I recommend keeping it simple—avoid using too many hair products, like gels or hairsprays, that can create buildup on your scalp," suggests Engelman. "Also, remember to wash your hair soon after you exercise to get rid of unwanted dirt or bacteria."
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Recently, during a lazy weekend in upstate New York, my boyfriend and I came across an episode of TLC's too-gross-to-turn-away series, Dr. Pimple Popper. Now, I have a pretty high threshold for blood and gore, but was I ready to see dermatolofgist Sandra Lee pop two giant cysts on a patient's head? I was not, and I will never look at gnocchi the same ever again. However, pimples on your scalp aren't just a TV phenomena, it's an everyday occurrence that many more people experience than you think.
"Scalp acne refers to pimples scattered throughout the scalp, whereas folliculitis refers to infections and/or inflammation around the hair follicles," explains Carlos A. Charles, a board-certified dermatologist in New York City. "[It's] typically seen more frequently in people that also have facial acne."
OK, so before you freak out, I spoke to a few more dermatologists and trichologists to get to the bottom of why scalp acne occurs in the first place — and how to prevent it in the future.
What is scalp acne?
We all know what pimples look like, but now imagine those around the hairline or even underneath your hair. Yep, that's scalp acne. On a more technical tip, according to Deanne Mraz Robinson, a board-certified dermatologist in Westport, Connecticut, scalp acne "is a form of folliculitis or inflammation of the hair follicles; at times it can be caused by irritation, bacteria, fungal, or other infections," she explains. "You can also have traditional acne around the hairline if you are prone to facial acne."
However, salon owner and trichologist Penny James further explains these aren't to be confused with seborrheic dermatitis (often due to an overactive serum on the scalp combined with inflamed skin causes large flakes of skin) or pilar cysts (which are filled with keratin from the hair follicle and relatively harmless). But be mindful of self-diagnosing yourself with "scalp acne," as it can have several etiologies and can occasionally be something more serious than the typical breakout.
If you're worried that your dandruff is definitely causing your pimples, according to Charles, there isn't a specific link between the two. "However, those with dandruff tend to have on overproduction of oil and sebaceous activity in the scalp," he says. "They also may be more prone to acne breakouts."
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How do you treat scalp breakouts?
Just like facial acne, there are a number of reasons why acne pops up on your scalp: stress, hormonal balances, certain foods, and abnormal immune responses can all be contributing factors. Often oil-based products like heavy pomades can cause clogging of the pores or glands, which makes washing (and styling) your hair with the right products even more important.
According to Shari Hicks-Graham, a board-certified dermatologist in Columbus, Ohio, those with oilier hair textures (or scalps) may be more predisposed to scalp acne or pimples "because the extra sebaceous gland activity that produces the oil also supports an environment that promotes bacterial growth — especially propionibacterium acnes — and other forms of bacteria like staph and strep."
What shouldn't you do if you get a breakout?
It is never a good idea to squeeze, pick, or pop a pimple on the scalp (or anywhere else) unless it is performed in a medical environment "with techniques and products to prevent ongoing trauma or infection of the skin," explains Hicks-Graham. "In many cases, the pressure from these behaviors causes the infection and inflammation of the pimple to go deeper into the skin and become more buried, which can prolong the course of the lesion."
Ultimately, this can lead to more scarring of the skin and hair loss. Moral of the story? Hands off.
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What can you do to treat scalp acne?
Make your wash-day routine count by lathering up with medicated shampoos formulated with antibacterial ingredients, such as sulfur and salicylic acid. "I suggest washing every other day," says Robinson. "It's best to lather and let the anti-inflammatory shampoo sit for five minutes before rinsing for best effect." She recommends Cln shampoo, which combines salicylic acid and dilute sodium hypochlorite to knock out itching, folliculitis, and dandruff.
If you head to your dermatologist, they may prescribe topical options such as topical clindamycin, erythromycin, benzoyl peroxide, salicylic acid, or glycolic acid. "For more severe cases, oral antibiotics or oral retinoids are prescribed," says Hicks-Graham.
What can you do to prevent scalp acne?
Despite a lack of information on scalp acne on the World Wide Web, Carlos assures that the condition isn't that uncommon and that he treats patients pretty frequently. "Helping to prevent oil and flaky build-up can be extremely helpful," he explains. "Ketoconazole shampoo (which can be purchased over the counter at a 1 percent strength or the prescription strength of 2 percent) are two good options."