Most of us refer to it as zits or pimples but acne is a common condition that can cause significant distress to any person. It is more frequently seen in the teen years of life due to the hormonal changes seen with puberty. Often it is more of a cosmetic concern, especially in the teen years of life where aesthetics is often considered as an important factor. Severe scalp acne can occur with complications like hair loss but this is uncommon.
What is scalp acne?
Scalp acne is a condition where blockage, inflammation and infection of the hair follicles on the scalp causes raised spots or bumps known as pimples. It is a common skin condition and the same as acne vulgaris, which commonly occurs on the face, chest, shoulders or back. Scalp acne may also involve the forehead. Minor cases can be itchy or sometimes painful but in most instances scalp acne doe not cause any significant problem. It is often covered by the hair.
However, in some cases scalp acne can be severe and form pustules or even nodules. Oozing discharge and matting of the hair may also occur with even balding in some instances although this is rare. There may even be keloid scarring on the forehead. As with other types, scalp acne is a combination of hormonal and environmental factors. Lifestyle and even genetics may play a role. Scalp acne can be treated and managed but is often persistent, especially around the teenage years of life.
Causes of Scalp Acne
There are multiple factors that contribute to the development of acne. Hormonal changes causes enlargement of the oil (sebaceous) glands. More oil (sebum) is produced and it can mix with dead skin cells as well as surface dust to form plugs that may block the pores. Further sebum that is emptied by the glands through the pores is the blocked. The follicle becomes inflamed. This may be further compounded by an infection of the follicle, usually caused by the bacterium, Propionibacterium acnes (P. acnes).
Contrary to popular belief, chocolate and greasy foods do not cause acne. However, skin and hair care applications can worsen the acne. With scalp acne, certain harsh hair care products can worsen the inflammation while oily applications may further exacerbate the natural ‘oiliness’ which contributes to the formation of plugs that blocks the pores. Hygiene may also have some role to play in it in that surface dust when not removed can also become part of the plug.
The changes in hormone levels seems to be a central factor in acne. This may be seen with puberty, menopause and the use of hormone medication like oral contraceptives.Psychological stress also seems to play a role and it is believed that stress may affect hormone levels as well. Hot and humid conditions, friction of head wear and even environmental pollution can contribute to the development of scalp acne. A strong family history of acne is also a risk factor.
Signs and Symptoms
Scalp acne typically presents with pimples and papules of varying sizes on the scalp. It can lead to an itchy scalp and even be tender to touch or painful. On closer inspection the pimples appear as red bumps or spots and it may be pustular. Sometimes these pustule may ooze a clear to yellow discharge. There may also be crusting.
There are different forms of scalp acne. In acne keloid there is thickening of the connective tissue which forms a band-like line typically at the hair line. A severe form of scalp acne is known as acne necrotica miliaris where tiny pustules burst and forms open wounds. This may not be isolated to the scalp. It can even occur on the face and torso in places where acne is more likely to arise.
Treatment of Scalp Acne
The treatment for scalp acne is not significantly different from acne elsewhere on the body. Topical applications are the first choice of treatment but in non-responsive or severe cases, oral medication may be necessary.
A range of topical applications may be used in the form of creams, ointments or shampoos. A regular shampoo can be useful as it helps to remove excess oil, skin cells and dust which may form a plug. Medicated applications manly contain benzoyl peroxide or salicylic acid which reduces oil produce and minimizes inflammation. Topical antibiotics may be applied when an infection is present.
The main drug used for acne is isotretinoin. It is a very effective treatment for acne but should only be used for short periods of time due to the host of side effects that it can cause. Sometimes oral antibiotics are also necessary when there is a severe infection that does not respond to topical antimicrobial applications.
Prevention of Scalp Acne
There are various lifestyle measures that can help to reduce the severity of scalp acne and play a role in preventing it to some degree. However, these measures may not able to prevent scalp acne altogether.
- Wash the scalp regularly. A mild shampoo like baby shampoo is sufficient and even baby soap will do. Washing the scalp and hair two to three times a week is suitable for most cases.
- Reduce the use of hair care products, especially hair oils. If hair styling products do have to be used then it should be washed as soon as possible. Hair dyes and other harsh chemicals should be avoided altogether.
- Sun exposure can aggravate the already inflamed scalp. Although head wear can protect the scalp, it should not be too tight or worn for long periods of time. It should be made of light airy material that does not contribute to increased perspiration.
- Minimize scratching of the head. This can injure the scalp and open wounds. It may also increase the chances of infection as the hands introduce bacteria to the surface of the head.
- Never pinch, squeeze or pop pimples with the fingers. This can cause extensive scalp damage and also increases the risk of infections which may further complicate the acne.