What is scalp acne
Just like acne on your face and body, scalp acne is caused by clogged sebaceous pores, or follicles, when there is a build-up of dead skin cells, debris, and oil, says Michele Green, MD, a board-certified cosmetic dermatologist based in Manhattan, New York. Other factors like product build-up, sensitivity to hair creams, garments worn on the head, common fungal infections of the hair, and excessive sebum on the scalp can all contribute to scalp and hairline acne, Dr. Green says.
Scalp acne may look and feel like regular pimples around the hairline or on the scalp. It can also appear as a single patch of pimples or several patches. It can even affect your entire scalp, according to Melanie Palm, MD, board-certified dermatologist at Art of Skin. It still counts as scalp acne if it spreads to your forehead, neck, or around your ears.
The most common and mild version of scalp acne is "scalp folliculitis," says Dr. Palm. It occurs around hair follicles, typically the back and sides of the head, she says. However, in rarer cases, Dr. Palm explains that severe and untreated fungal infections on the scalp can lead to a crusted, acne-like large mass called a kerion. This is a rare occurrence, but a professional should treat any fast-spreading, pus-producing, or significantly painful outbreaks.
How to treat and reduce scalp acne
First off, survey what you've been doing since the breakout arose. If you recently started using any new soaps, lotions, or shampoos, try to return to the products you were previously using to avoid a substance that could be irritating your skin. Additionally, if you have been breaking out from hats, scarves, or the collar of your winter coat, consider tossing them in the wash. Make sure you use a detergent that has historically been compatible with your skin.
What to avoid if you're dealing with scalp acne
Sodium lauryl sulfate: Dr. Green recommends that you avoid products that contain these ingredients because it has the potential to clog pores. A 2015 study published in Environmental Health Insights suggests that the ingredient can irritate the skin. Acne is an inflammatory condition, so any ingredient that causes more skin inflammation should also be avoided, Dr. Green says.
Too many products: Reducing the number of products you use can help you identify what might be causing the acne. "Limiting the use of hair products and using hair products which have gentle ingredients is another way to keep scalp acne at bay," says Dr. Green.
Silicone: Emilio Uribe, a professional hairstylist, recommends that you avoid silicone-based products as they can also be irritants. This is especially if you co-wash (which I will get to in a second).
Co-washing: Co-washes, or washing with conditioner, offer a gentler wash for some people with curly hair. This is useful for folks who feel shampoo with harsher ingredients sometimes dry their hair out or reduce the springiness of their curls. A 2019 study published in Skin Appendage Disorders took a look at the pros and cons of co-washing and found that, although co-washes can help keep hair moisturized, a clarifying shampoo was needed around every 15 days. This is because gentler shampoos tend to allow residue build-up, which can irritate the scalp and lead to clogged hair follicles.
Oils: Oily hair care products and makeup can trap dirt, dead skin cells, debris, and oil underneath in your hair follicles. To prevent scalp and hairline acne, avoid using hair products that contain oils or petroleum jelly like vaseline, says Dr. Green.
What to try instead
Scalp scrubs or detox treatments (for sensitive skin): "If you have hairline acne, I recommend that you should do a scalp scrub or scalp detox to keep your hair free of product build-up that has been deposited over the course of time," Uribe says.
Sensitive skin & acne preventative products: This is a common problem, so there are a lot of products out there that specify their safety for sensitive skin, says Dr. Green. These products usually say something like "oil-free," "non-comedogenic," "anti-acnegenic," or "won't clog pores," she adds.
Tea tree oil: One exception to the oil rule is tea tree oil. In the event of a fungal infection of the scalp, which is possible, you could use products that contain tea tree oil because of their anti-fungal properties, according to the Mayo Clinic. Though it would be useful to reach out to a provider for potential prescription medicines to treat a fungal condition on the scalp, Uribe recommends tea tree oil products because of their natural anti-fungal properties.
Shampoo with salicylic acid & other acne-fighting properties: There are shampoos available OTC formulated to help treat scalp acne. Shampoos formulated with pyrithione zinc, coal tar, selenium sulfide, ketoconazole, salicylic acid, and sulfur all work well on scalp acne, Dr. Green adds. She explains that these products work by reducing surface bacteria, excess oil, and inflammation, resulting in fewer breakouts.
Prescription medicine: You may need to consult a provider about scalp acne if it's causing you significant pain, consistently spreading or worsening over time, or taking a long time to heal. Sometimes antibiotics like clindamycin, dapsone, or prescription-strength shampoos might be necessary.
More best practices to consider
People who wear hats often develop scalp acne because of pore blockage and contaminants. Throwing your hats in the wash more frequently, cleansing the area your hat touches like the hairline, and taking breaks from hat-wearing can help prevent scalp acne.
You should also wash your hair after every exercise and whenever it begins to feel oily, says Courtney Rubin, MD, board-certified dermatologist and co-founder and chief medical officer at Fig 1. Additionally, avoid picking at the acne on the scalp and hairline, even though it could be tempting. This can potentially lead to scarring, hair loss, skin discoloration, and the spread of bacteria, she says.
Maintaining a frequent wash schedule if your hair is greasy, washing your hats, cleansing the face and skin near the scalp are all great ways to make sure the skin is clear and prevent scalp acne. Don't worry—you don't have to part with the beanie you wear every day in the winter. Just make sure to toss it in the wash every week.
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