Sores on Your Scalp: Causes and Treatments

Cysts

A cyst is a small sac that is usually filled with fluid or air, although it can be filled with other material. These smooth, firm lumps can develop in your hair follicles. The follicles anchor each hair strand to your scalp. Cysts can also form anywhere else on the scalp. They typically grow slowly and usually don't hurt, but sometimes they can get swollen and painful and may ooze a thick fluid that can have an odor. This can lead to a sore.

Cysts are usually harmless and most often go away on their own. But they can become infected if the fluid is filled with bacteria and pus, or if they break open and bacteria get inside – like when you’re brushing your hair or you scratch your scalp. This can also lead to a sore.

If a cyst or bump on your scalp bothers you or starts to get sore or ooze fluid, see your doctor.

Treating cysts on the scalp

Different types of cysts are treated in different ways.

• Sebaceous cyst. This is a slow-growing cyst under the skin of your scalp. It starts in the sebaceous gland that produces oil. It can be treated with a steroid shot, directly into the cyst. If it looks like the cyst might be infected (red, swollen, warm to touch), your doctor may use a needle to drain the fluid. If the cyst is large, it might be removed with a small cut. You might need antibiotics if the infection is serious.
• Epidermoid cysts, or epidermal cysts. These can look like sebaceous cysts but form under the skin. They can also form if the hair follicles are damaged. Although not usually needed, these cysts can be surgically removed with a small cut.
• Pilar cysts. These are rare. They grow from your hair follicles. If they pop or break somehow, or if they press down on your skin and cause pain, your doctor will need to remove them with surgery.

Scalp Acne

Just as you can have acne on your face, you can also get it on other parts of your body, including your scalp. The acne happens when the pores of your skin or the hair follicles get clogged. 

If acne breaks open, either on its own or because you’ve scratched or hit it with a comb or brush, it could cause a sore and scab over. Don’t ever pop acne, as this can also cause a sore. 

Treating scalp acne

If the scalp acne isn’t too bad, you might try treating it on your own. First:

• Stop using any hair care products that contain oil or leaves your hair feeling greasy.
• Wash your hair more often, especially after you’ve been sweating.
• Avoid wearing tight-fitting head coverings or headbands. If you need to wear a helmet, make sure there is good ventilation around your scalp.

If the acne doesn’t clear up, speak with your doctor. You might need:

• Antibiotics (cream, ointment, or pill) if the acne became infected
• Steroid cream or ointments if the acne caused folliculitis
• Oral medication called isotretinoin
• Oral antihistamines to relieve the itching
• Prescription shampoos for acne on the scalp

Folliculitis

If bacteria, a virus, or fungus gets into a hair follicle, you can get folliculitis. It may look and feel like a pimple, a painful red bump with or without a white head. These sores can be crusty and scabby, too.

Treating folliculitis on the scalp

If an infection caused the folliculitis on your scalp, you might need an antibiotic (for a bacterial infection) or an antifungal (for a fungal infection). These might be topical (creams or ointments) or oral (pills). 

Lice

These tiny bugs that get in your hair don't cause sores themselves, but they can make your scalp very itchy, and you might scratch. This can lead to painful and even infected sores. If you have lice, you may notice their eggs (about the size of pinhead) attached firmly to shafts of hair. You also may see the bugs, which are about the size of a sesame seed.

Special over-the-counter shampoos or lotions may be enough to get rid of lice. Talk to your doctor about other treatments if shampoos don't do the trick.

Scalp Ringworm

Ringworm, called tinea capitis when it’s on your scalp, is not a real worm. It's a common infection caused by a fungus. Ringworm goes by different names, depending on where it is on your body. Other types include jock itch and athlete's foot. 

It causes patches of itchy skin and hair loss that may get worse over time. You also may get a painful, pus-filled sore called a kerion on your scalp. Scalp ringworm is most common in kids, but it also can affect adults.

Treating scalp ringworm

The best treatment for scalp ringworm is usually prescription oral antifungal medication, such as griseofulvin and terbinafine. It can take up to 6 weeks for the hair to regrow over the spot. There are also some shampoos that your doctor might prescribe. While these don’t treat the ringworm, they prevent the fungus spores from spreading to other parts of the body or to others. 

Ringworm creams and powders don't tend to work on the scalp, so it’s best to see your doctor if you suspect scalp ringworm.

Scalp Psoriasis

This condition can cause patches of red, flaky skin on your scalp. These are called plaques. Since the plaques are often itchy, scratching can cause bleeding and scabbing. Psoriasis affects your whole body, so you might have plaques on other areas besides your scalp, such as your elbows and knees.

Treating scalp psoriasis

There’s no cure for scalp psoriasis, but you might be able to help manage the flare-ups when they happen. Special shampoos with coal tar or salicylic acid can help control it. Here are some other treatments your doctor might suggest to manage your scalp psoriasis:

• Topical (cream, ointment, or gel) corticosteroids
• Anthralin, a cream
• Oral medications, like acitretin, cyclosporine, or methotrexate
• Intravenous (IV) medications, like adalimumab, etanercept, or ustekinumab
• Phototherapy, a form of light therapy that directs ultraviolet light onto the psoriasis plaques.

Some people get relief from their psoriasis plaques by using:

• Aloe vera, applied two or three times a day
• Baking soda paste (2 teaspoons of baking soda mixed in a small amount of warm water) applied to the plaques. It’s left there for about 10 minutes and then gently rubbed into the area.
• Coconut or olive oil may help reduce inflammation.

Seborrheic Dermatitis

You probably know about the mildest form of this type of eczema as dandruff. But it also can cause scaly, itchy patches on your scalp that can ooze and scab over. You could also get sores if you scratch your scalp because it’s itchy. Symptoms tend to come and go and may be worse in winter.

Treating seborrheic dermatitis

There's no cure for seborrheic dermatitis, but there are some things you can do to help control the symptoms.

First you might want to try over-the-counter dandruff products. When using these products, let the shampoo stay on your scalp for a few minutes before rinsing it out. If they don’t work, your doctor might prescribe:

• Topical antifungal creams, lotions, or shampoos
• Topical products that have corticosteroids
• Creams or ointments that contain medications, such as pimecrolimus or tacrolimus
• Antifungals in pill form

Shingles

Although it’s not common, you can get shingles (herpes zoster) on your scalp. Shingles causes a red rash and fluid-filled blisters on the affected area. Shingles also causes intense itching, so you can be driven to feel like you need to scratch the area. Don’t do this because if you break the blisters open or break the skin in the rash, you can have an open sore on your scalp.

Treating sores on your scalp due to shingles

Treating sores or scabs on your scalp caused by shingles is the same as treating sores caused by infected acne or scratching and breaking the skin. You may need antibiotics if they become infected.

Skin Cancer

The most common form of skin cancer, called basal cell carcinoma (BCC), typically grows in areas most exposed to the sun, such as the head and neck, but it is also common on the scalp. Melanoma is a deadlier type of skin cancer and can be hard to detect.

BCC can cause:

• Scabs or scaly lesions on the skin
• Lumps or bumps on the skin
• Lumps that form ulcers (open wounds) that can bleed or ooze fluid

Melanoma can cause:

• A mole that’s changed recently in how it looks
• A small, scaly patch of skin
• A bump that doesn’t go away
• A sore or rash that doesn’t go away

Treating sores caused by skin cancer

Skin cancer is treated by an oncologist (a cancer specialist) or a dermatologist (a skin doctor) who has specialized in treating skin cancer. If you have any scalp sores, ask your doctor how to manage and treat them so they don’t bother you as much and to keep them from getting infected.

BCC can be treated by:

• Electrodessication and curettage: Scraping away and burning off the affected tissue
• Surgery to remove the lump or lesion
• Cryotherapy: Freezing the cancerous tissue to kill it
• Chemotherapy: Medication to kill the cancer cells
• Photodynamic therapy: A form of light therapy, using blue light to kill the cancer cells
• Laser therapy: Directing lasers to the cancer cells

Melanoma treatment depends on how far it has spread. It is easiest to treat in the earliest stages. These are some of the treatment options for melanoma. Your doctor will likely suggest surgery to remove the tumor as much as possible. Then you might get one or more of these treatments to kill the cancer cells:

• Chemotherapy
• Radiation therapy
• Immunotherapy
• Targeted therapy
• Vaccine therapy

Other Causes of Sores on the Scalp

They're not as common, but other conditions can cause head and scalp sores. They include viruses like chickenpox, and a group of rare autoimmune diseases called pemphigus, which happen when your immune system attacks healthy cells.

A couple of other caused are lichen planus and cutaneous lupus.

When to See a Doctor About Sores on the Scalp

You might not know you have a sore on your scalp unless you feel it or someone sees it. Trained barbers or hair stylists might be able to spot signs of skin cancer or other sores that you should have checked. 

You should see a doctor about sores on your scalp if they are:

• Moles that have changed in shape, size, or color
• Painful
• Bleeding or oozing fluid
• Getting bigger
• Not going away

You should also see your doctor if you get a fever while you have the sores.

Takeaways

There are many reasons why you might get a sore on your scalp, ranging from skin that breaks because it's scratched  too hard to skin cancer. If you’re concerned about any sores on your scalp, see your doctor or other health care professional so they can look at it. You may simply need a new type of shampoo or an over-the-counter medication. But it could be something more serious, so it’s always best to get checked.

Sores on the Scalp: FAQs

What causes sores on the head? Sores on your head or scalp can be caused by dandruff, eczema, pimples, or even skin cancer. There are many reasons why you could have a sore on your head.

What does it mean when your head is sore? There are many reasons why your head may be sore. You could have a headache because you’ve had too much alcohol the night before, or you might have a migraine. You could have an infected sore on your scalp that could cause pain. If your head is sore and you don’t know why, you should speak with your doctor.

How do you get rid of a sore on your head? How you get rid of a sore on your head depends on what caused it. If it’s a one-time thing, like you scratched and caused a sore, keeping it clean and watching for signs of infection are probably all you need to do. But if you get frequent sores – because you have psoriasis, for example – you need to get treatment for that root problem – the psoriasis – so you get fewer or no sores at all.

What causes sore bumps on the head? Sore bumps on the head could be caused by pimples, cysts, or even some types of skin cancer, among other things.

What causes red and dry patches on the scalp? Red and dry patches on the scalp could be caused by psoriasis, contact dermatitis, or some other skin condition.