Scalp pimples: causes, treatments, prevention 

Acne has a way of showing up when and where you’d least expect or want it to. Scalp acne is no less surprising or frustrating to deal with, especially painful pimples on the scalp. Why do these zits pop up on your head or hairline, and what can you do about them? Read on to learn what could be causing your scalp pimples and how to treat and prevent them.

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A scalp pimple is a buildup of oil, dead skin cells, and dirt that get trapped in hair follicles. This causes the skin around the follicle to become inflamed and form papules, pustules, nodules, or cysts. Sometimes, bacteria in the skin can infect scalp pimples, causing more flare-ups. Most cases of scalp zits are acne vulgaris, the most common type of acne.

Your body naturally produces sebum, which is a combination of oils and other fats, to help keep the skin lubricated and healthy. This substance comes from a gland in the skin called the sebaceous gland. If this gland is overactive or if the composition of the sebum changes for any reason, your pores may become blocked and form pimples—in this case, on your head (Rao, 2021).

Scalp acne can develop from a combination of genetics, hormone imbalances, stress, allergies, and lifestyle factors. If oily skin or oily hair runs in your family, you may be more likely to see pimples on your head. Some people are at higher risk for developing acne, depending on variations in genes that influence inflammatory responses and sebaceous gland function (Heng, 2021).

Evolution

Some scientists believe that we evolved to have a lot of active sebaceous glands on the scalp and forehead in order to accommodate the birthing process. These glands generate high levels of sebum at birth, but excess stimulation later in life can lead to acne (Shannon, 2020).

Sex hormones

Hyperandrogenism, an increased or abnormal activity of sex hormones, can cause pimples to form on the head by increasing sebum production and changing the balance of lipids (fats) in the sebum. Conditions like polycystic ovary syndrome (PCOS) are marked by hyperandrogenism and adult acne (Sutaria, 2022). 

Bacteria

The hair follicle is home to microbes such as Cutibacterium acnes (C. acnes). These bacteria influence sebum secretion, inflammatory response, and the formation of whiteheads or blackheads (Sutaria, 2022). Excess oil buildup on the skin or hair encourages these microorganisms to grow (Rao, 2021).

Diet

Some foods might also influence the development of scalp pimples. Highly processed foods, saturated fats, and trans fats may lead to your scalp breaking out (Podgórska, 2021). 

Also, people who regularly consume high glycemic foods tend to have more acne lesions than those who eat low glycemic foods, although more research is needed in this area (Baldwin, 2021). 

Medications

Oral birth control (specifically, progestin contraceptives), IUDs, SSRIs (selective serotonin reuptake inhibitors), and benzodiazepines are linked to acne breakouts. Lithium, bromides, and other drugs can also trigger or worsen head acne. Corticosteroids can make skin cells near hair follicles shed too rapidly, causing clumping and inflammation (Bagatin, 2019).

Stress

Stress makes your cortisol levels rise, which stimulates excess skin oil production that may result in acne. Sleep deprivation can also increase stress-related responses in the body, including acne outbreaks (Bagatin, 2019).

Cosmetics

Acne cosmetica is a reaction to cosmetics, hair care, or skincare products, such as makeup, shampoo, hair spray, or styling gel. These products can leave residue on the scalp, clogging pores. Acne cosmetica manifests as small bumps that make the skin look and feel rough. This skin condition usually does not cause inflammation (AAD, 2022). 

Tobacco

Tobacco is the primary cause of non-inflammatory acne, especially for females. Nicotine contributes to oxidative stress (damage to the cells) and can change the composition of sebum, increasing the risk of scalp pimple development (Bagatin, 2019).

How you treat pimples on the head depends on how severe your scalp acne is—also, the causes of this condition influence how your scalp responds to treatment. Cost, preference, and tolerance may also play a role in your treatment plan.

Cleansing

Wash your hair regularly, especially if it gets oily, sweaty, dirty, or weighed down with products. Oily hair needs special attention to avoid scalp zits—but don’t over-wash. Focus on cleansing your scalp and fully rinsing out shampoo and conditioner. Consider using a medicated shampoo or one that contains sulfur or salicylic acid. Studies show that this mineral may help reduce skin inflammation (Sp, 2021).

Look for hair care products or make home remedies with antibacterial essential oils. Bergamot, vetiver, sweet orange, and tea tree oil may help fight inflammation and the excessive secretion of hormones and oils that cause acne (Sun, 2020; Kurrimboccus, 2021; Mazzarello, 2018).

Topical treatments

Topical acne treatments are widely known to improve mild to severe scalp pimples. You might find that over-the-counter products with benzoyl peroxide can help. Prescriptions containing tretinoin or spironolactone may provide stronger results. 

Some scalp acne cases may require the use of antibiotics such as clindamycin, macrolides, and tetracyclines (Xu, 2019). Other topical treatments include physical extractions, light therapy, and steroid injections.

Bear in mind that some of these treatments may cause side effects in some people. Stop using them if they cause disruptive side effects, and see your dermatologist for help finding the right treatment option.

Depending on the cause of your head pimples, you can help keep scalp acne at bay with a few lifestyle adjustments. Keeping your scalp clean is the best way to reduce product buildup and head pimples, and look for cosmetic products labeled non-comedogenic. 

You can also take these steps to control scalp pimples:

• Avoid popping pimples; this could create more scarring and spread bacteria.

• Wash head coverings, bedsheets, and blankets to help protect your head from excessive contact with oil, dirt, and product residues.

• Keep a food diary to pinpoint if your acne flare-ups may be tied to what you’re eating.

• Eat more low-glycemic foods, focusing on omega-3 fatty acids, antioxidants, and dietary fiber (Meixiong, 2022).

• Limit the use of oil-based shampoos, moisturizers, or other hair products that may clog your pores.

• If medications are causing your scalp acne, ask your healthcare provider about adjusting doses.

If your scalp acne does not respond to these methods, or if it worsens, the pimples may indicate another condition. Scalp folliculitis, an inflammation in hair follicles caused by the yeast Malassezia, looks like acne vulgaris but often responds to different treatments (Malgotra, 2021). See a dermatologist for confirmation.

Now that you’ve learned more about what causes scalp acne, you can see that some factors are beyond your control. Fortunately, many people can manage this condition without medical attention. In severe cases, a dermatologist can point you to the best solution for alleviating your symptoms.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

May 20, 2022

Written by

Jeanna Smiley

Fact checked by

Chimene Richa, MD

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About the medical reviewer

Chimene Richa, MD

Dr. Richa is a board-certified Ophthalmologist and medical writer for Ro.