How to Treat Scalp Acne: Causes, Remedies & Prevention

We spend a massive amount of time, energy and our hard earned money on our skincare routines. We cleanse, exfoliate, moisturize and use targeted regimen on our faces to keep breakouts at bay. There is still one zone that often gets left entirely out of our usual consideration. It is the scalp. Discovering a painful bump while brushing your hair or running your fingers through your hair can be a jarring experience.

Scalp acne is an exceptionally common and a highly frustrating condition that many people suffer from in silence. Since it is hidden under the hair, it is totally easy to ignore until it becomes unusually uncomfortable, itchy as well as painful. Managing breakouts on your scalp requires a completely dedicated and targeted approach. Y

ou cannot easily slather the same skincare you use for your pimples on the face. Understanding the root causes of scalp acne, distinguishing it from similar clinical conditions as well as implementing a targeted strategy can help you prevent and manage your scalp acne in order to restore the comfort to your hair care routine.

Common Issues Of The Scalp

Scalp acne can be confused with other issues of the scalp. These may also require a unique targeted approach for the management. Consult a dermatologist or a specialized healthcare professional for proper diagnosis and personalized recommendations.

Scalp Acne	Scalp acne involves a clogged pore that becomes inflamed with proliferation of bacteria causing acne. It can appear as blackheads, whiteheads, papules, pustules, nodules or even highly painful cysts. It involves poor desquamation and overproduction of sebum as the key contributing factors of acne on the scalp.
Scalp Folliculitis	Scalp folliculitis is the infection of the hair follicle. It appears as clusters of small, uniform and red bumps centered explicitly around hair shafts. These are often topped with a tiny white pustule. It can be itchy or burning incredibly. Folliculitis is generally attributed to an inflammatory bacterial infection (usually Staphylococcus aureus) or a fungal infection invading a hair follicle damaged by friction, shaving or scratching.
Scalp Psoriasis	Psoriasis is a chronic autoimmune condition that accelerates the skin cell turnover drastically characterized by reddish patches, silvery-white scales and intense itching on the scalp.
Seborrheic Dermatitis	Often considered a severe form of dandruff, seborrheic dermatitis is an inflammatory skin condition linked to an overgrowth of Malassezia yeast. While its basic symptoms are greasiness, intense itching and yellowish scales. It can also cause red, irritated, inflammatory papules across the scalp and along the hairline.

Why Scalp Acne Matters

More than just an invisible nuisance, scalp acne is a major dermatological condition. This condition can have a direct negative impact on your hair health. When scalp follicles are chronically inflamed/infected, strong inflammatory responses within can actually damage the tissue beneath the skin surface permanently.

This causes scarring alopecia (which makes hair fall out permanently and thin out locally while the tissue is replaced by scar tissue) along with an increased itchiness that causes one to compulsively scratch their scalp. The itchiness worsens hair by weakening neighboring hair follicles, causing premature shedding.

Besides that, recurring scalp breakouts can indicate an internal alarm for other health issues in your body. Most conditions that come off as regular acne breakouts could actually be pityrosporum folliculitis. The condition has to be treated with antifungal medication because it's actually caused by an overgrowth of a fungus called Malassezia. Other conditions you might be suffering from include hormonal imbalances such as high androgen levels, PMOS, etc.

The scalp is also uniquely prone to various secondary infections on the skin areas surrounding it, such as forehead acne or neck acne. Given the amount of constant friction that occurs on the scalp everyday, popping or scratching a pimple on the scalp will increase inflammation on those areas and allow pathogens to go deeper and produce irritation. Use the dedicated Alite Skincare products like

These are formulated with some of the best anti-acne active ingredients to help in the prevention and management of acne.

The day-to-day reality of scalp acne ends up as significant discomfort which inhibits your normal lifestyle. Simple things like brushing, combing, blow drying or even shampooing your scalp becomes painful while using styling tools that aggravate active lesions on the scalp. Simply putting on essential daily items on your head such as helmets, hats or headphones often can lead to throbbing pain due to pressure along with head acne.

Apart from the daily physical discomfort, the psychological and emotional impact of scalp acne can significantly influence the overall quality of one’s haircare routine. Breakouts that become prominent and appear on the hairline will add to significant self-consciousness, social anxiety and low self-esteem. A cycle of stress develops here whereby being anxious causes cortisol levels to rise which then leads to increased sebum production and a worsened condition of the scalp pimples.

A Deeper Dive In The Science Behind Scalp Acne

In order to understand the science involved in scalp acne and why this part of our body is so prone to acne, you first need to understand its unique anatomy. Your scalp is made up with some of the thickest dermal layers in your body and it consists of a very high density of terminal hair follicles in your scalp. Closely associated with these hair follicles are sebaceous (oil) glands in the form of pilosebaceous units.

These glands continuously produce sebum which is a natural oil that functions actively to lubricate the hair shaft and form a protective as well as waterproof barrier over the stratum corneum (top layer of the skin). In a perfectly balanced skin microbiome and barrier health, sebum flows freely out of the pore which keeps the scalp supple and the hair healthy.

The main mechanism of formation of scalp acne includes:

Poor Desquamation--There is constant shedding of mature, old and dead skin cells generally. When these cells do not shed properly, they’ll contribute to plugging of the pore openings.

Overproduction Of Sebum--Several factors including hormones, stress, genetics, environmental stressors, etc. can stimulate and alter the quality as well as quantity of the sebum released onto the skin surface. This overproduced sebum has the ability to mix with trapped impurities like dirt, pollutants, dead skin cells, makeup residue and other accumulated grime to clog the follicular openings.

Microbial Attack--The sticky entrapped sebum mixed with the buildup of dirt and dead cells create an anaerobic environment with an optimal moisture content for microorganisms like Malassezia furfur (microbe responsible for fungal acne) and Cutibacterium acnes (microbe responsible for bacterial acne) to grow and multiply exponentially.

Inflammation--The acne causing microbes feed on the trapped sebum and trigger an inflammatory immune response in order to tackle the overgrowth of microbes causing acne and irritation on the skin barrier. This results in clustered red, swollen and sometimes pus-filled acne lesions hidden beneath your hair.

Treating The Key Triggers Of Scalp Acne

Hair Cosmetics

Occlusive and greasy hair cosmetics can block the follicular openings resulting in blockage of the pathways for proper sebum regulation on the scalp and hair. It results in promotion of formation of acne on the scalp. The appearance of acne lesions due to cosmetics is also popularly known as ‘acne cosmetica.’ You need to switch to non-comedogenic haircare and scalp-care products with composition that has a high safety profile for regular use. Regular removal of the cosmetic build up from the skin of the scalp is also essential to fight scalp acne.

Friction

The aggressive friction due to common use items like helmets, tight headbands, work gear, etc. It can cause acne lesions on the scalp named ‘acne mechanica.’ This form of acne is triggered by a combination of physical friction and local occlusion. Wearing them in a normal routine can add to the mixing of buildup of dirt with sweat and sebum on the surface of the skin. If a tight head gear presses down on the scalp for an extended period, it will physically force that trapped buildup down into the hair follicles. The warm and humid microclimate created under such head gear acts as an incubator for bacterial and fungal growth. You should clean and wash the head gear regularly before use. Avoid wearing tight head gear for longer periods of time.

Improper Hair Cleansing Routine

When you avoid cleansing your scalp and hair regularly, you tend to allow days of accumulated sebum, sweat, pollutants as well as dead skin cells to totally accumulate and entrap undisturbed in a stubborn manner.

Washing too often with harsh or heavy foaming shampoo can strip the scalp's natural moisture barrier at the same time. This can lead to severe dryness on the scalp prompting the sebaceous glands to overcompensate by flushing the pores with even more oil. This adds to the stretching of the clogged pore walls resulting in appearance of enlarged pores and triggering of inflammation and acne. Use gentle and effective Cleansers for your skin which not only have acne fighting actives but also work actively to repair the damaged skin barrier.

Hormonal Triggers

Your skin on the scalp usually is having a significant distribution of pilosebaceous units. These units are highly sensitive to internal biochemical shifts. Fluctuations in certain hormonal levels in the body such as androgens (male hormones present in both men and women) tend to stimulate the sebaceous glands by binding to the sebaceous glands to produce larger volumes of thicker and more viscous sebum. These shifts are commonly observed during puberty, menstrual cycles, pregnancy, perimenopause or frequent episodes of high psychological stress. Consult a physician for proper diagnosis and assessment of the hormonal levels in the body that may be contributing towards scalp acne.

Dietary Factors

Diets usually rich in high-glycemic index foods such as refined sugars, white bread and processed snacks cause rapid spikes in blood insulin. This can trigger a cascade that promotes systemic inflammation and sebum production on the scalp as well. Follow a balanced diet with foods having low glycemic load and rich in vitamins and minerals for improved skin health.

Environmental Stress

Prolonged sun exposure of the skin in the harmful and skin-damaging UV rays can put the skin and scalp through oxidative stress with the increased production of free oxygen radicals. High heat and humidity in the weather can also influence the sebum and sweat release on your skin. Pollutants like dirt, heavy metals and smoke present in the surroundings can trap on the acne-prone skin and mix with sticky sebum and dead cells to plug the pores on the scalp, aggravating the active acne on the scalp. Use non-comedogenic thermal protectant hair care for the scalp and hair.

What We Discussed

Scalp acne is an inflammatory skin condition. It can be painful, itchy and frustrating. It also needs to be distinguished from folliculitis, psoriasis and seborrheic dermatitis. The basic mechanism behind scalp acne including dense follicles, sebum buildup, microbes, inflammation and triggers like hair products, friction, cleansing habits, hormones, diet and stress have been discussed in detail. The main takeaway is to use targeted, non-comedogenic scalp care, cleanse gently, reduce friction and get proper medical advice when symptoms persist for a longer period of time for proper evaluation and targeted management of the scalp acne.