Article by Dr. Marcie Ulmer MD, FRCPC, FAAD
Brushing, combing and styling the hair can be uncomfortable when you have scalp acne because the pimples on the scalp may be tender. Some people feel self-conscious or embarrassed when the acne lesions are seen on the scalp if the hair is thin or if acne bumps are visible along the hairline or extend onto the back of the neck.
Dr. Marcie Ulmer, a Vancouver dermatologist and spokesperson for the Acne and Rosacea Society of Canada, helps us understand what scalp acne is, the causes and treatments.
We know that acne is a disorder of the hair follicle (the structure from which a hair grows and into which the oil glands open) and that it occurs on the body where there is hair, including the scalp. Scalp acne is the bumps of acne distributed along the hairline or scattered over the scalp underneath the hair. The acne lesions may be red bumps, pus filled bumps or deeper inflammatory cysts.
Just like acne at other body sites, scalp acne is caused by inflammation and clogging of the hair follicles with skin cells, debris, bacteria and sebum (oil). An overproduction of sebum is linked to increased numbers of the bacterium Cutibacterium acnes, a key player involved in the inflammation of acne lesions.
Scalp acne may have a hormonal component in women. Some women notice an acne flare related to their cycle, often prior to menses.
Like many diseases genetics may play a role in acne including scalp acne.
People with oily hair may be predisposed to scalp acne. The extra oil gland activity on the scalp produces the excess oil seen on the scalp and hair. This excess oil is linked to increased bacterial growth including growth of Cutibacterium acnes which is implicated in the development of acne.
Scalp acne is more often seen in patients who have acne at other body sites as well.
Scalp acne is less common than acne at other body sites but it is a condition dermatologists see regularly.
Many cases of scalp acne are mild with a few scattered pimples possibly worse at times of stress or with flares related to hormonal changes. If scalp acne is more severe, persistent and inflammatory it can cause problems such as scarring and hair loss.
Over-the-counter products containing salicylic acid can be quite beneficial for this condition. It is relatively easy to use a salicylic acid shampoo regularly for scalp acne (frequency of washing will depend on hair type), leaving it on the scalp for a few minutes after lathering before rinsing. When lathering, use the fingertips for gentle exfoliation on the scalp to remove built up skin cells, hair products and excess oil.
For more severe scalp acne prescription therapy may be needed: options include topical or oral antibiotics, steroid injections on the scalp, isotretinoin, and the birth control pill or spironolactone (in women). It is worth noting that some of the topical therapies we traditionally use for acne on the face or torso are more difficult to apply to the scalp because of the presence of hair. Oral therapy is often more practical at this location.
Don’t pick your acne. Keeping your hands off is the best thing you can do (and sometimes the most difficult). Picking/squeezing/popping the pimples on the scalp may cause more inflammation, trauma and infection in the skin, not only prolonging the time the pimples remain but also increasing the risk of scarring.
Don’t use products that contribute to blocking the hair follicles/pores. Scalp acne can be exacerbated by a build-up of certain styling products like hairspray, heavy pomade, wax, paste, hair oil, dry shampoo and gel.
Do wash your hair regularly and thoroughly. Dry shampooing does not count as washing your hair as it does not actually cleanse the scalp of dead skin cells and oils. Dry shampooing absorbs/masks the scalp oil which is timesaving and may look great but is not recommended if you are experiencing scalp acne. The product, skin cells and oils will further contribute to clogging the pores.
Don’t apply hair repair treatments, oils and hair masks to the scalp but rather try to limit application to the damaged ends of the hairs. The same goes for conditioner. Ideally minimize applying it directly on the scalp and instead apply it to the length of the hair shaft and particularly on the dry ends of the hair.
Do look for hair products that are labeled oil free or non-comedogenic/non-acnegenic.
Do see your doctor if your scalp acne is bothering you or if you think you may be experiencing scarring or hair loss because of it.
If scalp acne is associated with genetics or hormonal causes it cannot truly be prevented (but remember it can be successfully treated). Avoiding certain hair care practices may be beneficial in minimizing development of scalp acne (see above).
Just like acne at other body sites, inflammation and picking can cause scarring. When scarring occurs on the scalp you see associated hair loss. Once scarring occurs on the scalp the hair loss is permanent so the best way to treat scalp acne is to treat it early on and avoid picking to prevent the scars from occurring in the first place.
If scalp acne is mild, an over-the-counter treatment approach with a salicylic acid containing shampoo and changing hair care practices may be all that is needed to solve the problem. If the degree of the scalp acne is more severe, it is important to see your family doctor or dermatologist. There are very safe and effective prescription medications that can be used to treat this condition and help prevent any lasting problems.
About the Author
Dr. Marcie Ulmer MD, FRCPC, FAAD is a dermatologist at Pacific Derm in Vancouver and spokesperson for the Acne and Rosacea Society of Canada. She is a Clinical Instructor at the University of British Columbia.
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