It’s nice that scalp zits are hidden and all (as opposed to the facial variety), but they can often be the most painful type of pimple (especially when you brush, ugh). They’re also the hardest to treat because—you guessed it—they’re covered by your hair.
“The main cause for acne on the scalp is that cells and oil get stuck in the hair follicles,” says Whitney Bowe, M.D., a dermatologist in New York City. “As the dead skin cells and oil accumulate on the scalp, they serve as food for bacteria that turns into acne.”
This happens most commonly to those with naturally oil-prone scalps or people who sweat often. So what can you do to treat scalp acne? Your best prevention strategy is to wash your hair regularly. Yes, we know the latest talk—the less cleansing, the better—but hear us out. “If you just rinse the hair with water, you’re not getting rid of the oil,” says Bowe. “You do need some of these almost detergent-like molecules where one part attracts water and the other attracts oil. The oil binds to oil on your scalp, and then the water attaches to the water as you rinse, so it can actually bind to the extra oil and wash it down the drain.”
And don’t think you can replace a regular shower session with dry shampoo, either. “You’re just masking the oil,” says Bowe. “You still have a buildup of dead skin cells and oil that bacteria loves to eat.” Plus, a buildup of product can also lead to clogged pores, another cause of acne.
In addition to regular shampooing, scalp massages should also become a part of your routine. The gentle rotation of your fingertips is just enough to gently exfoliate, says Bowe, who advises staying away from harsher exfoliators, like the ones you use on your face. (Remember your scalp is delicate!) “Exfoliating your scalp is a double-edged sword,” she says. “It’s hard to exfoliate the scalp without creating trauma to the hair follicle. The hair itself might actually come out [or look dull and damaged].”
In terms of treatment, the fastest option is to see your dermatologist. “I inject the pimple with cortisone, and that’ll clear the skin within a day,” says Bowe. It’s important to treat pimples on your scalp quickly to avoid infections, says Bowe. “People have a tendency to pick their scalp acne even more so than anywhere else on the body,” she says. “There’s something about how uncomfortable it is on the scalp.” All of that picking can lead to staph infections, which Bowe says are very common on the scalp.
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For both the prevention and long-term management of scalp acne, Bowe generally recommends oral antibiotics and probiotics (here’s how to pick the right probiotic). “I find that acne has a lot to do with the balance of good bacteria versus bad bacteria, so I usually recommend an antibiotic along with a probiotic,” she says. The last resort is Accutane. “It actually dries out the oil glands so they can’t pump out oil, [which is] the main cause of scalp acne,” she says.