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All You Need to Know About Scalp Acne and How to Treat It

The most common types of acne are facial acne and acne on the back. Similar to acne on other parts of the body, scalp acne is also a fairly common concern, especially among acne-prone individuals. This is annoying and sometimes worrying, as it may cause hair loss. Let us explore more about scalp acne in this article and how to get rid of it.

Why Does Acne Occur on The Skin?

Pimples, sometimes referred to as zits or blemishes, occur when hair follicles are clogged by bacteria, dead skin cells, and excess oil. Our skin has sebaceous glands that produce sebum, the body's natural oil that coats, moisturizes and protects our skin. When the body produces excess sebum due to factors such as excess androgens, poor diet, and stress. It can lead our skin to become oily, clogged and cause acne, especially if we do not exfoliate and cleanse our skin properly.

Why Does Acne Appear on the Scalp?

Just like acne on your face, chest or back, acne can appear on your scalp too. One of the causes of scalp acne breakout is called acne cosmetica, which takes place when unsuitable shampoo or hair products come into contact with the hair or skin. It can also be due to not washing their hair frequently or wearing headgear frequently that causes friction against your scalp.

Scalp Folliculitis is a condition that is often confused with scalp acne due to their similar appearances. It is discerned by formation of red and itchy nodules on the scalp. However, unlike acne, scalp folliculitis is an infection by Staphylococcus aureus, mites or yeast and requires a different treatment strategy. Furthermore, it is only limited to the hair follicles. However, studies have found that both scalp acne and folliculitis may often occur together and might be associated with each other[1].

Can Scalp Acne Cause Hair Loss?

Severe scalp acne may impact the health of the hair follicle and cause hair loss. Androgens are not only responsible for causing acne on the scalp but can also shrink your hair follicles and shorten the growth cycle[2]. This results in thinner, more brittle hair, as well as rapid hair loss. Hence, if you are suffering from severe scalp acne, it is important to consult an aesthetic physician for appropriate treatment before hair loss becomes more prominent.

Treatment for Scalp Acne

Treating scalp acne is very similar to treating acne on the face, chest or back[3] as the causes of acne are similar. Here are some treatment options that you can consider.

LED PhotoLight Therapy

Blue light therapy is the type of light therapy most commonly used to address acne breakouts. The wavelength of blue light has an antimicrobial effect, making it effective at killing several types of bacteria that can collect in your pores and oil glands and cause breakouts. Red light therapy helps your skin to heal faster by simulating collagen and fibroblast production. Infrared light helps to reduce inflammation. When utilized in the correct effective combination, it can help to neutralize ongoing breakouts and prevent new acne formation[4].

Medicated Shampoo

Shampoos with exfoliating agents like salicylic acid and glycolic acid can be an effective treatment for scalp acne. These exfoliants can remove excess sebum, dirt, and dead skin cells from the scalp to unclog the pores. Additionally, hair products with anti-bacterial ingredients can kill the acne-causing bacteria to curb the infection, while hair serum with retinols can help to reduce sebum production. Do note that benzoyl peroxide, a popular anti-acne ingredient for face and body acne, may not be suitable for the scalp as it may bleach or damage the hair.

Oral Medication

  • Isotretinoin

Isotretinoin, a derivative of vitamin A, is an efficacious oral medication for moderate to severe acne. Isotretinoin shrinks your sebaceous glands and reduces sebum production[5]. Side effects include skin irritation, rash, dry skin and joint pain. While generally considered safe for most people, doctors will require patients to be reviewed regularly to monitor progress and side effects closely.

  • Antibiotics

Antibiotics treat acne by killing or preventing acne-causing bacteria growth or Propionibacterium acnes (P.acnes) on your scalp. The anti-inflammatory properties of antibiotics also help to reduce inflammation and swelling. However, they are not recommended to be use as a long-term solution as bacteria can become resistant to antibiotics overtime[6]. Other side effects of antibiotics for acne includes gastrointestinal symptoms such as nausea, vomiting or diarrhea as well as more sensitivity to UV light. Antibiotics are not the only option for treating moderate to severe acne. Studies has shown that combining other medical grade treatments can help protect against antibiotic resistance and better results[7].  

  • Oral Contraceptives

If scalp acne is caused by hormones, oral contraceptives with progestin and estrogen may be prescribed to lower the level of androgens in the body and reduce sebum production[8]. Side effects of oral contraceptives include spotting between periods, nausea, breast tenderness, headaches & migraine, weight gain, mood changes, light or missed periods, and decreased libido. It is also to important to note that birth control pills are only suitable for women over the age of 14, reached puberty and started menstruating as taking them before starting menstruation can damage your hormones. Women with history of depression are also not advised to take oral contraceptives, as it may worsen their condition. 

Blood clotting in your heart, lungs, brain, or legs is also a serious complication of birth control pills. The risk is increased in women: 

  • Who smokes
  • Aged 35 and older
  • Medical conditions such as high cholesterol, high blood pressure, diabetes, and conditions that increase the risk of blood clotting 
  • Confined to bed rest or wearing a cast   
  • Spironolactone

A medication known as spironolactone may be recommended by your doctor if you don't want to take oral contraceptives. This medication is commonly used to treat high blood pressure and heart failure. However, it can also help to slow down your body’s production of androgen hormones which causes excess sebum production[9]. While it does help with reducing acne, spironolactone pills can lead to high blood potassium especially in patients with kidney problems as well as other side effects such as breast tenderness, weight gain, loss of libido for males, irregular menstrual cycles and dehydration.

In resistant case, you may be prescribed both oral and topical medications.

How To Prevent Scalp Acne?

  • Avoid applying oil-based or comedogenic products to your hair and scalp.
  • If you are getting acne along your hairline, then avoid applying any oil-based or comedogenic products on your forehead.
  • Avoid using too many hair products that can cause buildup on your scalp. These include hair sprays, hair gels or pomades. Use a clarifying shampoo to cleanse your scalp thoroughly if you use such products frequently.
  • Wash your hair whenever your roots get sweaty, such as after a workout or a day out in the sun.
  • Wash your pillowcases, hair towels, and headgear regularly.
  • Avoid tight-fitting headgear or caps that can cause an accumulation of sweat on the scalp.
  • If you have an acne-prone scalp, use a salicylic acid-based shampoo once a week as a preventive measure.
  • Avoid inflammatory foods that your body may react to such as refined grains and sugar, bread made from white flour, soda and sweeteners.

Acne on any part of the body is concerning and scalp acne may be extra bothersome for many due to the risk of hair loss and confusion regarding the right treatment. However, just like face and body acne, you can treat and prevent scalp acne with the right products and treatments. If you are facing scalp acne concern and over-the-counter solutions aren’t working for you, be sure to consult an aesthetics physician.