What to Know About Scalp Acne

Medically Reviewed by Stephanie S. Gardner, MD on July 24, 2023
5 min read

Scalp Pimples

Scalp pimples are very common, but making a few adjustments to your hair routine can usually clear it up.

Scalp acne is when pimples and breakouts happen on your scalp or hairline. Acne can be a complex skin condition, but it generally happens because of four processes:

  1. An increase of sebum, or oil, production
  2. A buildup of dead skin cells and dirt in your hair follicle
  3. Inflammation in the blocked hair follicle
  4. An increase in acne bacteria

Your scalp is full of hair follicles and oil glands. If the follicle or pore becomes clogged with dirt and oil, this can lead to acne. You can still get scalp acne even if you have good hygiene, but sweat, oil, and dirt buildup from improper or incomplete washing can lead to clogged pores.

However, you may need to reexamine your hair care routine. Lots of scalp pimples are caused by shampoo, styling gel, and hairsprays that leave residues on your scalp and also clog your pores. 

Scalp acne caused by hair products is so common that it has its own medical name: acne cosmetica. 

Hormones can also cause acne. Androgen hormones, especially testosterone, cause your body to make more oil. The increase of hormones during puberty is often responsible for acne, but adults can have hormonal acne too. 

Genetics will affect your skin. If you have an immediate family member who has acne, you’re more likely to have it too.

Acne is usually graded by severity and by the type of pimples you have, which might change your treatment. ‌

Types of acne severity include:

  • Mild
  • Moderate
  • Severe‌

Types of pimples include:

  • Blackheads, called open comedones
  • Whiteheads, called closed comedones
  • Papules, or inflamed bumps
  • Pustules, or bumps filled with pus
  • Nodules or cysts, which are painful pimples deep in your skin
  • Mixed, which is a combination of types

Sometimes you can get severe forms of acne that can affect your scalp called acne conglobata and acne fulminans. These are very uncommon.

Scalp acne can appear throughout your hair or along your hairline. Common symptoms include:

  • Tiny bumps along your forehead or the back of your neck.
  • Tiny bumps you can feel but can’t see.
  • Tiny bumps packed together that you can see.
  • Whiteheads on your scalp or hairline.
  • Flesh-colored bumps on your scalp or hairline.
  • Painful bumps on your scalp.
  • Deep cysts under your skin with no head‌.
  • Itchiness 

Sometimes acne affects your emotions and self-esteem. It’s common for people to feel embarrassed and even depressed because of acne. 

If your scalp acne is caused by your shampoo or other cosmetics, it will go away on its own when you stop using them. It can take up to 6 weeks to see improvement, but the first thing to do is to change your hair routine and products. ‌

Switch to shampoo, conditioner, hair spray, and products that don’t contain oil. The label should say things like:

  • Oil free
  • Non-comedogenic
  • Anti-acnegenic
  • Won’t clog pores‌

Keeping the dirt, oil, and sweat off your scalp will help keep your pores clean. You might need to wash your hair more often, especially if you:

  • Have oily hair
  • Use a lot of products in your hair
  • Sweat a lot in the day
  • Have dirt or grime in your hair from the day‌

To wash your hair, focus on the scalp. The hair on your head is dead, and while your hair products can help keep your hair shiny and healthy-looking, it’s actually more important to wash dirt and oil from your scalp.‌

It’s also important to make sure you fully rinse all the extra shampoo and conditioner off your scalp and face. The pimples along your hairline might be caused by buildup from improper rinsing.‌

The product residue can also transfer to whatever touches your hair, which can add to the problem. Make sure to wash everything that touches your head, including:

  • Pillowcases
  • Hats
  • Visors
  • Headscarfs
  • Headbands
  • Bedsheets
  • Blankets‌

Scalp Acne Shampoo

If thorough rinsing doesn’t help, you may be able to manage scalp acne by changing to products that are oil-free and antibacterial. Also look for: 

  • Anti-dandruff shampoo that contains selenium sulfide, tar, or zinc pyrithione   
  • Antifungal shampoo that containsciclopirox or ketoconazole
  • Salicylic acid shampoo
  • Sulfur shampoo

Other Treatments for Scalp Acne 

If topical remedies don’t ease your scalp acne symptoms, you might need other treatments. These can include:

  • Antibiotics 
  • Photodynamic therapy
  • Drainage for complicated cystic scalp acne
  • Steroid injections directly into cysts

Lots of times scalp pimples are from shampoo or other products. Just making a switch to your hair routine can get rid of the problem without any other treatment. Other times, scalp acne is a bit more complicated and needs other treatment. The outlook for scalp acne is good, but if it doesn’t get better with some of these changes, talk to your doctor.

A condition that can look similar to scalp acne is folliculitis decalvans. It's a rare form of alopecia or hair loss. Scientists aren't sure exactly what causes it, but they think it may be an abnormal response by the body to the bacterium Staphylococcus aureus. 

Folliculitis decalvans usually begins in adulthood. The primary symptoms are patchy hair loss with inflammation, and pimple-like sores around the area where hair falls out. It usually affects the skin on your scalp, most often on the back of the head. You'll notice irritated spots with sores or pimple-like bumps on them. You may have discomfort in the affected areas. The affected hair will fall out, leaving round or oval-shaped bald patches.

Major symptoms of folliculitis decalvans include: 

  • Patches of hair loss
  • Clusters of pustules around bald patches
  • Several hairs growing out of a single follicle, causing a tufted appearance like the bristles on a toothbrush
  • Redness or swelling of the scalp

There is no cure for folliculitis decalvans, but some treatments can relieve symptoms. They may include:

  • Oral antibiotics to clear up any sores or pustules that are on your scalp
  • Topical antibiotics that can reduce the presence of staphylococcus aureus
  • Isotretinoin to treat pustules
  • Oral or topical corticosteroids to reduce inflammation, pain, and itching
  • Photodynamic therapy to reduce the severity of symptoms