Dermatologist reveals what causes scalp acne and how to prevent it

Scalp acne or pimples is a very common problem encountered when breakouts happen on the scalp or hairline. Similar to facial or body acne, scalp acne also occurs because of 4 reasons explains Dr. Jyoti Gupta a Dermatologist. But sometimes, the condition may not be acne and can be confused because of similar symptoms. These can be fungal acne, folliculitis, folliculitis decalvans, and dissecting cellulitis of the scalp which are more severe and do not respond to conventional treatment lines.

1. An increase in oil or sebum production: this can happen due to oil massages, an increase in hormone testosterone (which can occur with puberty, weight gain or hormonal issues) and supplements containing steroids or androgenic substances like whey protein.

2. Increase in dead skin layer clogging pores: it is majorly seen in people with infrequent hair washing habits, working habits in sweat or dirt and application of hair styling products like gel or wax.

3. Inflammation in hair follicles: due to blockage of the hair follicles, there is usually an inflammatory reaction causing redness, pain and swelling. People with stress, anxiety, inadequate sleep and wrong lifestyle habits can develop more of this reaction.

4. Increase in Propionibacterium acnes production: this is the bacteria which once formed, causes the spread of acne and makes it much more severe and widespread

Pimples usually manifest as small bumps which can have pus-filled in them. Along with it, there can be swelling, pain and itching. Normally, they heal without any sequelae but some scarring, if caused, can lead to loss of hair permanently from that area. Though loss is very minimal, a frequent loss can lead to visible baldness on the scalp. It also leads to a decrease in quality of life as there is frequently painful, itchy episodes which can lead to loss of self-esteem, feeling of embarrassment and even depression too.

Treatment for scalp acne

Lifestyle modifications:

Healthy diet, smoking cessation if any, decrease in intake of whey or isolate, steroid intake, decrease in weight, anxiety management helps in long term control.

Change in styling habits by decreasing products usage on scalp like wax, pomade, dry shampoos. Use of heat styling like straightening or use of heat for drying the hair should be reduced. Tying of pony tightly can reduce acne in hair line. Hair oil massages or any massage on scalp should be stopped. If oil application is needed, a gentle application can be done 30 mins before hair wash

Frequent cleaning of pillows, headbands, scarf, bandana, and helmets may also be required in these cases.

Shampoo usage:

Frequency can be as much as daily if there is high production of oil and if the collection of dirt or sweat is present on daily basis. Shampoo should be majorly applied on the scalp and not on hair strands. Depending on the scalp condition, shampoo can be –

•    antibiotic or antiseptic based (cetrimide/ betadine)

•    keratolytic or exfoliating based (salicylic acid-based)

•    antifungal based (ketaconazole/ climbazole etc)

•    anti-inflammatory based (steroids in selected cases, zinc sulphate)

Along with these, anti-acne creams/gel application is usually required and sometimes oral antibiotics have to be prescribed to curb the infection. In severe and resistant cases, hormonal treatment and oral oil reduction medications have to be given for long term remissions. One needs to consult a dermatologist, where evaluation by examination and tests like culture of pathogenic organism and biopsy may have to be done to reach a proper conclusion to get proper treatment.