Pimple on Scalp: How It Happens and How to Treat It

Acne on the scalp, or scalp folliculitis, is most common along your hairline. This condition can cause small and itchy pimples. Sometimes these pimples also become sore and crusted.

A pimple on your scalp may be:

• mild, includes blackheads and whiteheads
• moderate, includes papules and pustules, which appear on the skin’s surface
• severe, includes nodules and cysts, which are imbedded under the skin

Severe scalp acne (acne necrotica and dissecting cellulitis) can develop blackened crusts and leave permanent scars. Contact your doctor if you are experiencing persistent acne that’s causing hair loss, bald patches, or severe pain.

You can treat a pimple on your scalp with many over-the-counter (OTC) products. But visit your doctor if the pimple lingers or you suspect it might be something else.

Pimples occur when pores, or hair follicles, get clogged. This can occur when dead skin cells, naturally occurring oil that keeps the skin moisturized (sebum), and bacteria enter the pores. The cells cannot exit the pore, which results in acne in a variety of forms. More severe forms of acne contain more bacteria.

The types of organisms that cause this inflammation include:

• Propionibacterium acnes (P. acnes)
• Staphylococcus epidermidis
• fungus
• mites

Reasons for clogged pores may include:

• product buildup from shampoo or other hair products, such as gel or hairspray
• not washing hair frequently enough to clean scalp
• waiting too long to wash your hair after a workout
• wearing a hat or other headgear or equipment that’s caused friction against your scalp

The key to treating scalp acne is to prevent your pores from clogging. It’s the oil blockage and buildup that causes acne. Keeping your scalp clean is important. But you’ll want to make sure your shampoo or conditioner isn’t causing your scalp acne.

If you suspect your shampoo or conditioner is causing the issue, you may consider trying some new products. For mild and moderate acne try products with ingredients like:

• salicylic acid (Neutrogena T/Sal Shampoo): exfoliates dead skin cells so they do not enter pores and cause acne, but less effective than benzoyl peroxide
• glycolic acid (Aqua Glycolic): helps with exfoliation and kills micro bacteria
• ketoconazole or ciclopirox (Nizoral): antifungal agents in antidandruff shampoos
• tea tree oil (Trader Joe’s Tea Tree Tingle): antibacterial properties may help fight acne
• jojoba oil (Majestic Pure): may not get rid of acne, but adding to your shampoo may help reduce acne inflammation

Use oil-based products in moderation to avoid clogging your pores. If you also use hair products like waxes, pomades, hair sprays, and clays, you may want to invest in a sulfate-free clarifying shampoo (Ion). Clarifying shampoos remove dirt, oil, and product buildup from your hair. Avoid using this type of shampoo too often as it can dry out your hair, especially if it’s been dyed or heat-damaged.

Shop for clarifying shampoos.

Medications for scalp

Talk to your doctor if OTC therapies don’t work or if you start experiencing hair loss. You may need a prescription treatment to reduce inflammation. For severe or persistent cases, your doctor may recommend:

• topical antibiotics or steroid cream
• oral medications, such as antibiotics or antihistamines
• isotretinoin, for severe acne
• light therapy
• steroid injections
• physical extractions to clear pores

Do not continue using a product if you suspect you are allergic to it.

If your pimple does not respond to acne treatment or seems like it could be something else, contact your doctor.

The affected area may be another condition, such as:

• skin cancer, such as a basal cell or squamous cell carcinoma
• a deep infection or abscess
• seborrheic dermatitis, a common condition that leaves scales, redness, and dandruff
• a cyst

Acne treatments typically take up to four to eight weeks to begin to work. You may also have to keep treating the area to avoid recurrences. Dermatologists recommend using a mild, everyday shampoo if you need to wash your hair frequently. This can be used alongside an instant conditioner. Studies have shown that mild shampoos do not interfere with normal hair growth.

Pimple scars can take up to six months to fade. It’s important not to pick at acne as this could create deeper scarring. It may also spread the bacteria.

As you continue to treat your acne, be sure to be gentle when massaging your scalp. Avoid scrubbing with your fingernails as this can irritate the skin and open wounds.

Determining the cause (such as clogged pores) and making lifestyle changes can help with acne prevention. You’ll also want to look for products that won’t cause too much buildup on your scalp and won’t dry it out. This includes waxes, hair sprays, clays, and other hair products that are free of certain chemicals and additives.

For a list of comedogenic ingredients, visit acne.org. Comedogenic ingredients are known to clog pores, especially for people with sensitive skin. Popular comedogenic ingredients that you may find in shampoos and conditioners include sulfates and laureth-4.

Reducing scalp irritation may help decrease cases of scalp acne.

Remember to wash your hair after working out, wearing headgear, or other possible activities that caused sweating. Keeping your sleeping area clean, including changing your pillowcases and taking off makeup (to prevent acne along the hairline) may help too.

Diet and scalp acne

One review of diet and acne suggests that what you eat can affect oil production, inflammation, and acne. The American Academy of Dermatology doesn’t recommend focusing on diet as your only treatment.

For an anti-acne diet, try limiting carbohydrate-rich foods and increasing foods with:

• vitamin A
• vitamin D
• omega-3 fatty acids
• dietary fiber
• antioxidants
• zinc

If you note a flare-up after eating a particular food, you may want to consider eliminating it from your diet. Keep a food diary to keep track of what you’re eating and when flare-ups occur.