Ever get a red, painful bump on your scalp that feels like a pimple? Chances are, it is: scalp acne is fairly common, according to dermatologist Sandra Lee, MD (aka Dr. Pimple Popper). It can pop up whether you’re dealing with chronic acne, or just a pimple every once in a while.

Here, we’re sharing Dr. Lee’s advice about how to treat and prevent scalp acne.

What causes scalp acne?

Remember that all acne is a combination of factors, including excess oil. So it follows that breakouts tend to occur where there’s a preponderance of sebaceous glands releasing that oil — and that includes your scalp.

When one of your hair follicles fills up with oil and dead skin, it can form a pimple. Commonly, scalp acne falls into one of these categories:

• Acne mechanica: tight-fitting headgear like hats, helmets, headbands or hair extensions irritate the skin and occlude the pores
• Acne cosmetica: pore-clogging hair products build up and block the pore opening 
• Acne vulgaris: common acne that's affected by genetics

Because of its location, explains Dr. Lee, scalp acne is affected by several other factors — including occlusive hair products, sweat, and lack of ventilation. This is especially true in those with thick hair, or who need to wear hats or helmets regularly.

What does scalp acne look like?

Just like breakouts elsewhere on your face and body, scalp acne can fall into one of two types:

• Non-inflammatory: also known as comedones, including blackheads and whiteheads
• Inflammatory: red, raised papules, pustules, nodules and cysts

A breakout on your scalp can be widespread and chronic, or it can consist of a pimple or two that pops up from time to time.

How do you treat and prevent scalp acne?

According to Dr. Lee, step one of managing scalp acne is figuring out what’s contributing to it. Haircare products are often the culprit, she says, because they can contain comedogenic ingredients like:

• Coconut oil
• Synthetic fragrance
• Silicones
• Cocoa butter
• Soybean oil

Here are Dr. Pimple Popper’s tips for dealing with scalp acne:

• Figure out if cosmetics are the culprit. Just like with makeup, taking a break from your haircare products and reintroducing them one at a time can help you determine if they’re the problem. Then, you can swap out the comedogenic or harsh products.
• Wash your hair consistently. No matter your skin type, it’s easy to tell when your hair gets greasy and needs a good shampooing. Both over- and under-washing can lead to scalp breakouts, so experiment and find the frequency that works best for you.
• Try a medicated shampoo. Products that contain salicylic acid (which helps reduce pore-clogging buildup) are a good over-the-counter choice for treating scalp acne at home. Tea tree oil and sulfur can also be beneficial. Avoid antibacterial soaps containing triclosan, because it’s a hormone disruptor.
• Apply a spot treatment. If you’re dealing with an occasional pimple or two on your scalp — as opposed to persistent, widespread acne — a spot treatment is a good option for you. Look for salicylic acid, says Dr. Lee, which is less likely than benzoyl peroxide to bleach your hair. Try: SLMD Salicylic Acid Spot Treatment. For more coverage and along the hairline, try SLMD AHA/BHA Swipes, which contain 3 chemical exfoliants.
• Clean your hats and gear. Bacteria can build up on the inside of your hats, headbands, and helmets, so regular washing is a must. In between, try Dr. Lee’s favorite hack: spritz on SLMD Salicylic Acid Body Spray and let dry before wearing.

When to see a dermatologist for your scalp acne

Though it can be tempting to try every treatment under the sun to get rid of your scalp acne, it’s wise to use one at a time, advises Dr. Lee. That way, you can tell for sure which product is working for you.

If your scalp acne doesn’t start clearing up after following Dr. Lee’s protocol for a couple of months, it’s best to make an appointment to have it checked out by a dermatologist. You might need a prescription-strength treatment, or you might not be dealing with acne at all. 

Scalp conditions that look like acne

Sometimes, bumps that appear on your scalp are not acne, but instead are a sign of another skin condition. Lesions that are sometimes mistaken for scalp acne include:

• Ingrown hairs: pimple-like inflammation caused when a hair grows back into the skin, causing irritation
• Pilar cysts: hard, keratin-filled bumps that form near the hair root and usually do not have a white head
• Skin cancer: bumps or irregular scalp lesions that could be a sign of squamous cell carcinoma
• Seborrheic dermatitis: a waxy buildup leading to red, scaly patches with dandruff-like flakes
• Pityrosporum folliculitis: inflamed follicles and pus-filled pimples, often accompanied by itching

These last two conditions are caused by a yeast-like fungus and can be treated with antifungal shampoos and steroid creams. Before self-diagnosing or treating any scalp condition, talk to your dermatologist.