Scalp acne, also termed folliculitis, is a less talked about but equally troublesome variant of acne that primarily affects the scalp. Although similar to acne on the face or body, scalp acne is distinct due to its location, often covered by hair. This hair coverage makes it more challenging to notice, diagnose, and treat. The condition can range from mild, with just a few pimples, to severe, featuring numerous painful sores.
This article with Dr Justin Boey, Medical Director of Sozo Aesthetic Clinic, will help you understand the unique nature and challenges of scalp acne. This understanding serves as the first step in exploring practical treatments and preventive measures.
Contents
What is Scalp Acne?
Scalp acne is a skin condition that develops when the hair follicles on the scalp become blocked or inflamed. Just like acne on other parts of the body, it is primarily caused by the accumulation of oil, dead skin cells, and bacteria. The main characteristics of scalp acne include redness, swelling, and the formation of pus-filled pimples or papules. These can be itchy or tender, causing discomfort, especially when combing or brushing the same hair follicle. In severe cases, untreated scalp acne can lead to hair loss. Its occurrence can be sporadic or chronic, affecting individuals regardless of age or gender.
How Scalp Acne Forms?
The process of scalp acne formation is similar to how acne develops into pimples on your scalp or other body parts. It begins with the sebaceous glands, located beneath the scalp’s surface, adjacent to hair follicles. These glands produce sebum, an oil that helps moisturise the skin and hair. However, when these glands produce excess sebum, it can mix with dead skin cells and congest the hair follicles. This can result in an overgrowth of bacteria, specifically Propionibacterium acnes, which thrive in oily environments. The bacteria cause inflammation and the formation of acne lesions or pimples on the scalp. Factors like hormonal changes, poor hygiene, or certain hair products can exacerbate this process, leading to more severe scalp acne.
Causes of Scalp Acne
A variety of factors can trigger scalp acne. These can be broadly divided into external and internal causes.
External Causes
Hair and Scalp Products: Certain hair products contain ingredients that can clog the pores on your scalp, leading to acne. This includes heavy oils, silicones, and petroleum-based products. Always opt for non-comedogenic products to avoid this issue.
Hygiene Practices: Inadequate or irregular scalp cleaning can result in the build-up of oil and dead skin cells, contributing to acne formation. Conversely, excessive washing or scrubbing can irritate your scalp and disrupt the natural oil balance, leading to acne.
Environmental Factors: Factors such as humidity, heat, and pollution can stimulate the sebaceous glands to produce more oil, increasing the risk of scalp acne.
Internal Causes
Oil Production: Overactive sebaceous glands can produce excess oil, leading to clogged pores and acne breakouts. This can be natural or caused by factors such as diet and stress.
Hormonal Changes: Hormones can play a significant role in the development of acne. Fluctuations in hormone levels, particularly during puberty, menstruation, pregnancy, or menopause, can stimulate oil production, leading to acne.
Genetics: Some individuals may be genetically predisposed to acne, including scalp acne. If your parents had scalp acne, you’re also more likely to develop it.
Health Conditions: Certain health conditions, such as polycystic ovary syndrome (PCOS), can cause hormonal imbalances that lead to acne.
Symptoms of Scalp Acne
Scalp acne’s symptoms are similar to acne on other body parts, although they can be hidden under the hair. The most common signs include:
Small Bumps: Little, often tender or itchy bumps on the scalp are a primary symptom. These can range from simple pimples to cystic acne, which is large, inflamed, and painful.
Redness and Swelling: The area around the affected hair follicles may become red and swollen.
Pus-filled Lesions: Over time, the bumps may fill with pus. They can be painful and may leak when pressed or scratched.
Scalp Tenderness or Itching: The scalp may feel sore and sensitive to touch, especially when combing or brushing the hair. An itchy scalp can also indicate the presence of scalp acne.
Hair Loss: In severe cases, frequent and untreated scalp acne can lead to hair loss. This occurs due to the damage caused to hair follicles by the inflammation.
Flaking: Sometimes, scalp acne can be accompanied by flaking of the skin, which could be mistaken for dandruff.
Scalp Acne vs. Other Scalp Conditions
Scalp acne, dandruff, and psoriasis are distinct conditions with unique characteristics.
Scalp Acne vs Dandruff
Dandruff is a common condition characterised by the flaking of the scalp’s skin. It differs from scalp acne in several ways:
Dandruff is primarily associated with a dry scalp, while acne typically stems from an oily scalp.
The flakes of dandruff are larger and white, while the inflammation in scalp acne results in red or pus-filled bumps.
While both can cause itching, the primary discomfort with scalp acne tends to be tenderness or pain at the spot of the acne lesion.
Scalp Acne vs Psoriasis
Scalp psoriasis, on the other hand, is an autoimmune condition that causes raised, red, scaly patches on the scalp. These patches can be sore or itchy, much like scalp acne. However, psoriasis extends beyond the scalp, often affecting the forehead, back of the head, neck, or behind the ears. The thick scales of psoriasis are silver-white and very thick, while scalp acne presents as smaller, inflamed, and often pus-filled bumps. Furthermore, while hormonal fluctuations, excess oil, and bacteria are primary culprits in scalp acne, psoriasis is driven by an overactive immune system.
Who is at Risk for Scalp Acne?
Scalp acne can affect anyone, regardless of age or gender, but it is most prevalent amongst teenagers and young adults, a period when hormonal fluctuations are at their peak. These hormonal changes can increase sebum production, setting the stage for acne development. However, scalp acne isn’t restricted to the younger demographic. Adults can also experience outbreaks, especially during periods of stress or hormonal imbalances such as menopause or due to health conditions like PCOS.
People with naturally oily scalps or their hair frequently those who sweat excessively are also more susceptible to scalp acne, as the excess oil and sweat could clog hair follicles, promoting acne. Similarly, individuals with a genetic predisposition to acne are at a higher risk. You may be prone to developing scalp acne if you have a family history of acne.
Poor hygiene practices, such as not washing your hair regularly or adequately, can also contribute to the likelihood of developing this condition, as it allows for the build-up of oil and dead skin cells on the scalp. Conversely, washing hair too frequently or using harsh products.
Treatment Options
The treatment options for scalp acne are similar to those used for other types of facial acne. These include:
Over-the-Counter Treatments
Over-the-counter treatments can manage mild scalp acne by reducing oil production, combating bacterial infection, reducing inflammation, or accelerating skin cell turnover. Here are some widely available options to treat scalp acne:
Salicylic Acid: Salicylic acid is a common ingredient in acne treatments due to its ability to penetrate and cleanse pores. Shampoos or salicylic acid treatments can help exfoliate the scalp and reduce acne formation.
Benzoyl Peroxide: This powerful acne-fighting ingredient kills bacteria, reduces inflammation and helps unclog pores. Be aware that it can bleach hair and fabric.
Sulphur: Sulphur helps break down dead skin cells and reduce sebum production. It can be found in some specially formulated shampoos and conditioners.
Tea Tree Oil: Known for its antimicrobial and anti-inflammatory properties, it can be a natural alternative for treating scalp acne. However, it should be used sparingly as it can dry out the scalp if used excessively.
Glycolic Acid: This alpha-hydroxy acid can help exfoliate the scalp and unclog hair follicles. It is often found in medicated shampoos and scalp treatments.
Prescription Treatments
For moderate to severe cases of scalp acne, prescription treatments may be necessary. These topical medications often have stronger active ingredients and are formulated to target stubborn acne. Below are some prescription treatments for scalp acne:
Topical Antibiotics: Topical antibiotics, such as clindamycin or erythromycin, can be prescribed by doctors to manage scalp acne. They work by eliminating the acne-causing bacteria on the skin.
Topical Retinoids: Retinoids like tretinoin, adapalene, and tazarotene can effectively treat acne by promoting cell turnover and preventing the clogging of hair follicles.
Oral Antibiotics: For more severe cases, oral antibiotics may be necessary. Doctors may prescribe doxycycline, minocycline, or tetracycline to control bacteria and reduce inflammation.
Oral Retinoids: In severe cases, doctors may prescribe oral retinoids, such as isotretinoin, to reduce skin oil production. However, these medications have severe side effects and are often considered a last resort treatment.
Hormonal Therapy: For women experiencing scalp acne due to hormonal imbalances, hormonal therapy, such as birth control pills, may be recommended to regulate hormones and reduce acne.
Natural Remedies for Scalp Acne
Natural remedies can sometimes be an effective alternative or supplement to over-the-counter or prescription treatments. Here are a few options you might consider:
Apple Cider Vinegar: Apple cider vinegar’s antibacterial and antifungal properties can help fight the bacteria causing scalp acne. To use it, dilute it with water in a 1:1 ratio, apply it to your scalp, and rinse after 10 minutes.
Aloe Vera: Aloe Vera has anti-inflammatory properties that can soothe and heal acne lesions. It also helps moisturise the scalp. Apply pure aloe vera gel to your scalp and rinse after 20 minutes.
Coconut Oil: Coconut oil possesses antimicrobial properties, which can help reduce acne. You can apply a small amount of virgin coconut oil to your scalp and massage it for a few minutes before rinsing.
Honey: Honey, specifically raw and unpasteurised honey, has natural antibacterial properties, which can help eliminate acne-causing bacteria. Apply it to the affected area, let it sit for 10-15 minutes, then rinse with warm water.
Green Tea Rinse: Green tea is rich in antioxidants, which can help reduce inflammation and oil production. You can make a green tea rinse by brewing two bags in water, letting it cool, and then rinsing your scalp after shampooing.
Essential Oils: If you’re struggling with scalp acne, essential oils like lavender or rosemary can be helpful as they have antimicrobial and anti-inflammatory properties. To use them, mix a few drops of the essential oil with a carrier oil like jojoba or almond oil, and massage the mixture into your scalp. After 15-20 minutes, rinse it off. This should help manage your scalp acne.
Prevention and Maintenance
Maintaining a healthy scalp and preventing the occurrence of scalp acne can often be achieved by adopting the following practices:
Regular Cleansing: Keeping your scalp clean by washing your hair regularly is essential. However, avoid over-washing, as this can strip the scalp of its natural oils, leading to dryness and irritation.
Choose the Right Hair Products: Opt for hair care products that are non-comedogenic, meaning they won’t clog your pores. Avoid products with harsh chemicals and instead choose those with natural ingredients.
Healthy Diet: A balanced diet rich in fruits, vegetables, lean proteins, and whole grains can provide the necessary nutrients for maintaining a healthy scalp.
Stay Hydrated: Drinking adequate amounts of water throughout the day can help maintain the health of your skin and scalp.
Avoid Touching the Scalp: Frequently touching your scalp can transfer oils and dirt from your hands, potentially leading to clogged pores and scalp acne.
Manage Stress: High-stress levels can trigger acne breakouts. Engaging in regular stress management activities such as exercise, meditation, or yoga is important.
Maintain Good Hygiene: Regularly clean any items that come into contact with your scalp, such as hats, headphones, or pillowcases, to prevent the build-up of dirt and oil.
Choosing the Right Hair Products
Selecting hair products that won’t exacerbate or trigger scalp acne is crucial to managing this condition.
Non-Comedogenic: Look for hair products that are labelled as non-comedogenic. These products are specially formulated to not clog pores, which is vital in preventing acne breakouts.
Natural Ingredients: Try to choose products that incorporate natural ingredients, as these are typically gentler on the scalp. Ingredients like tea tree oil, aloe vera, chamomile, and lavender have soothing and anti-inflammatory properties.
Avoid Harsh Chemicals: Products containing harsh chemicals such as sulfates, parabens, and alcohol can irritate the scalp and lead to breakouts. Always check the product’s ingredients list before purchasing.
Oil-Free: If you have an oily scalp, consider using oil-free shampoos and conditioners. These products can help reduce the amount of oil on your scalp, decreasing the likelihood of developing acne.
Fragrance-Free: Fragrances added to hair products can sometimes irritate the scalp, leading to inflammation and acne. Opt for fragrance-free products if you have a sensitive scalp.
Hypoallergenic: Hypoallergenic products can be a good option for those with sensitive skin or allergies. These products are free from common allergens and are less likely to trigger a reaction.
Dilute Your Products: If your products are too strong or irritating, consider diluting them with water. This can help to reduce their intensity and make them gentler on your scalp.
Proper Hair Care Routine
Establishing a proper hair care routine is paramount in managing and preventing scalp acne.
Regular Washing: Wash your hair every 2-3 days, using lukewarm water to open up the hair follicles and clean away any build-up of oil and dirt. Avoid washing your hair daily, as this can dry out your scalp and lead to overproduction of oil, exacerbating acne.
Use a Gentle, Non-Comedogenic Shampoo: Choose a mild, non-comedogenic shampoo that won’t clog your pores. Look for one with natural ingredients, such as tea tree oil or aloe vera, which can soothe scalp irritation, and have anti-inflammatory properties.
Condition With Care: Apply conditioner only to the ends of your hair and avoid the scalp area. This minimises the risk of pore-clogging and reduces oil build-up on your scalp, which can lead to severe acne too.
Rinse Thoroughly: Ensure you rinse all the shampoo and conditioner from your hair. Any product residue left on your scalp can build up over time, potentially leading to acne.
Gentle Drying: After rinsing, pat your hair dry with a soft towel rather than rubbing it, which can irritate. Avoid using high-heat settings on hair dryers, as this can dry out and irritate your scalp.
Scalp Treatments: Consider incorporating a scalp treatment into your routine once or twice weekly. This could be a tea tree oil treatment, an apple cider vinegar rinse, or a specialized scalp scrub. These treatments can help exfoliate your scalp, keeping it clean and preventing acne.
Stress Management
Stress significantly contributes to many health issues, including scalp acne, as it can trigger the body to produce more oils on the skin. Therefore, managing stress levels is key to maintaining scalp health and preventing acne breakouts.
Exercise: Regular exercise releases endorphins — natural mood lifters — that help to reduce stress and improve overall well-being. This, in turn, can promote healthier skin and scalp.
Meditation and Yoga: These practices help to calm the mind and relax the body, reducing the stress that can contribute to overactive sebaceous glands in the scalp.
Healthy Sleep Patterns: Getting sufficient sleep is critical for the body’s overall health and managing stress. Sleep can disrupt hormonal balance, potentially increasing oil production and acne.
Balanced Diet: A diet rich in antioxidants, Omega-3 fatty acids, and vitamins can boost the immune system and help the body better cope with stress.
Relaxation Techniques: Techniques such as deep breathing, progressive muscle relaxation, or visualisation can help lower stress levels, promoting a healthier scalp.
Social Connection: Positive interaction with friends and family, or even pets, can help elevate mood and reduce stress, supporting healthier skin and scalp.
Professional Help: If stress becomes overwhelming, seeking help from a mental health professional can be beneficial. Therapies such as cognitive-behavioural therapy (CBT) can provide effective strategies for managing stress.
Dietary Considerations
Our diet significantly impacts overall health, including the health of our skin and scalp. Certain foods can trigger inflammation and contribute to acne breakouts, while others possess properties that promote skin health and potentially reduce acne.
Low-Glycaemic Foods: Diets rich in low-glycemic foods such as whole grains, fruits, vegetables, and lean proteins can help maintain stable blood sugar levels and reduce inflammation, potentially lessening the risk of acne breakouts.
Omega-3 Fatty Acids: Foods high in omega-3 fatty acids, like fatty fish, walnuts, and flaxseeds, have anti-inflammatory properties that may help reduce the severity of acne.
Antioxidants: Including foods rich in antioxidants, such as berries, dark chocolate, and leafy green vegetables, can help protect your skin from damage and inflammation.
Water: Staying well-hydrated can help maintain skin hydration and remove toxins from the body, potentially reducing the likelihood of acne.
Limit Dairy and Sugar Intake: Research suggests high dairy or sugar consumption might be linked to acne. Being mindful of these intakes could help manage acne.
Vitamins and Minerals: Foods rich in vitamins A, E, and zinc can help combat acne. These nutrients are found in nuts, seeds, and sweet potatoes.
When to See a Dermatologist
If your scalp acne persists despite trying various treatments or becomes painful, inflamed, or spreads, it’s time to consult a dermatologist. Instances of severe scalp acne, cystic acne, or acne that leaves scars should not be ignored. The professionals at Sozo Aesthetic Clinic are equipped with the expertise and technology to identify the root cause of your acne and propose suitable treatment strategies.
From its unique approach to managing skin problems to its state-of-the-art facilities, Sozo Aesthetic Clinic ensures the highest level of care for your skin and scalp health. Don’t allow persistent acne to become a source of discomfort and self-consciousness; reach out to the team at Sozo for a consultation.
Conclusion
Scalp acne can be uncomfortable and frustrating, but managing and preventing outbreaks with the right approach is possible. Maintaining good scalp hygiene, managing stress levels, and being mindful of our diet can promote healthier skin and prevent scalp acne. In cases where home remedies are ineffective, seeking professional help from a dermatologist can provide the necessary support and treatment.
