What causes scalp acne and how to get rid of it

At Curology, we don’t treat folliculitis, but sometimes treatments intended for acne may help. If the bumps are stubborn, we recommend seeing an in-person medical provider.

Are you experiencing bumps on your scalp? You may think this is scalp acne, but think again: According to our experts, in some cases, this may be folliculitis. Knowing the difference is vital to getting the proper treatment, and Curology is here to help! Here we’ll explain the difference between “scalp acne” and forehead acne, their possible causes, and tips for treatment and prevention. If you’re wondering, “Why do I have acne on my scalp?”—this one’s for you.

What is scalp acne?

Acne doesn’t typically occur on the scalp. If you see or feel little bumps above your hairline, you likely have a different skin condition, such as folliculitis or acne keloidalis nuchae, or something else altogether, like head lice. That said, acne does occur on the hairline and forehead, and it can be mild, moderate, or severe. 

What does hairline acne look like?

Acne is an inflammatory skin condition that affects people of all ages, including adults, teenagers, and children. It’s characterized by blackheads, whiteheads, and inflammatory lesions such as pimples, papules, and pustules.¹ Acne can occur in many places, including along your hairline. We understand how frustrating this can be! To help you identify hairline acne, here’s what it may look like: 

• Tiny bumps on the forehead: If you have hairline acne, you may see small bumps on your forehead. 

• Inflamed bumps on the forehead: The bumps near your hairline and on your forehead may also be red and inflamed. 

• Itchiness on the forehead: Hairline acne on your forehead may also be itchy. If this is the case, it may be fungal acne.  

If your scalp pimples are occurring above the hairline, they are likely the result of a different condition. Folliculitis is a skin condition commonly mistaken for scalp acne, so we’ll focus on that. 

Folliculitis is inflammation of the hair follicles. It may be related to an infection in the follicles. In addition to your scalp, it can appear anywhere on the skin except for the palms and soles. Folliculitis can look like a sudden acne breakout; in some cases, each spot may have a red ring around it. This is a sign of a potential infection.²

What causes ‘acne’ on the scalp (folliculitis)?

Folliculitis can occur when your hair follicles become damaged because it’s easy for germs to get inside them and cause infection. A common source of infection is Staph aureus, which is normally found on the skin, but other organisms could also be the culprit.³ Here are some potential causes of folliculitis: 

• Fungal or bacterial infection: Fungal or bacterial infection may cause your hair follicles to become inflamed and damaged. 

• Shaving, plucking, or waxing: These harsh hair removal methods can contribute to folliculitis.

• Rubbing/friction: Frequently touching or rubbing your skin may trigger folliculitis.

• Tight clothing: When skin is damp and hot, hair follicles are more likely to become damaged and infected. Hats and other tight headgear can rub against your skin while you’re exercising or out and about on a hot day.

• Hot tubs or whirlpools: Enjoying a dip in a hot tub or whirlpool may be relaxing, but it can also cause acne-like breakouts to appear on the skin. This typically occurs approximately 12-48 hours after using a hot tub or whirlpool.

Hairline acne, on the other hand, may be caused by the following: 

• Hair product, sebum, or bacteria build-up: When comedogenic hair products, oil, and bacteria build up along your hairline, it can lead to breakouts. 

• Not washing your hair thoroughly or frequently enough: If you have hairline acne, try washing your hair more often. Be sure to rinse thoroughly. 

• Hormone fluctuations: Androgens, which are a type of hormone, are known to play a role in acne.⁴

How to help prevent folliculitis and forehead acne

Between hormones, hot tubs, tight apparel, and more, it can be hard to narrow down what’s causing your folliculitis or forehead acne. Once you’ve figured that out, how do you stop it from happening? Here’s the good news: If you’re experiencing folliculitis on your scalp or acne on your forehead, there are several ways to help prevent it.

• Shower soon after exercising: Practicing proper hygiene is key to preventing a recurrence of folliculitis.⁵ This is why our dermatology providers suggest showering (or at least rinsing your face!) right after exercising. 

• Use non-comedogenic products: Clogged pores can lead to acne, so reach for non-comedogenic products to help prevent it. 

• Avoid using oily hair products: If you’re using hair care products such as shampoos, gels, hairspray, waxes, or pomades that contain a lot of oil, these may be the culprit.⁶

• Let your scalp breathe: Avoid wearing tight headgear to give your scalp and forehead some breathing room.

How to help treat folliculitis and forehead acne

If you’ve already got it, you might be wondering how to get rid of scalp “acne” (folliculitis) ASAP. Luckily, the acne-like breakouts associated with folliculitis tend to go away on their own if you tackle the cause and have a healthy immune system.⁷ If your folliculitis doesn't go away on its own, a couple of ingredients may help treat it: 

Ketoconazole

Ketoconazole is a common treatment for folliculitis. In one study, 75% of participants who received oral ketoconazole treatment alone, as well as a combination of oral and topical ketoconazole therapy for folliculitis experienced an improvement.⁸ It's often used for dandruff and seborrheic dermatitis, and its anti-androgen effect may also help reduce oiliness and hair loss.⁹ 

Zinc pyrithione

Zinc pyrithione is an antifungal drug and one of the most widely used ingredients in medicated shampoo. Although it’s primarily used for dandruff and seborrheic dermatitis, it is also a good shampoo for scalp acne, particularly on the forehead and hairline.¹⁰

Tea tree oil

Tea tree oil’s antimicrobial and anti-inflammatory properties may help treat folliculitis.¹¹ Try using a tea tree oil shampoo that’s formulated with non-comedogenic ingredients. 

Unlike folliculitis, forehead acne may be less likely to disappear on its own and is treated with different ingredients and medications:

• Salicylic acid: To help fight your forehead acne, look for a non-comedogenic product containing salicylic acid, such as a facial cleanser or moisturizer. Salicylic acid is a beta-hydroxy acid with potential anti-inflammatory properties that is frequently used to treat acne.¹²

• Isotretinoin: Isotretinoin (also called Accutane) is a powerful prescription oral acne treatment that delivers a high dose of vitamin A. Isotretinoin is a vitamin A derivative that’s approved by the Food and Drug Administration for treating severe acne. Treatment must be overseen carefully by a licensed dermatology provider, as high doses of vitamin A can have negative side effects.¹³

• Oral or topical antibiotics: Forehead acne may be treated with oral or topical antibiotics. Doxycyline is an oral antibiotic that’s commonly used to treat acne. Topical therapies include clindamycin and erythromycin.

• Ketoconazole: The antifungal agent ketoconazole may help treat fungal acne. A study found significant improvement in acne lesions when treated with 2% ketoconazole cream.¹⁴

If you think you may have folliculitis, you can seek professional guidance from a medical provider or dermatologist. Although Curology can’t diagnose or manage bumps on the scalp—which are often mistaken for acne—we can treat true acne, including breakouts at the hairline and on the forehead.

Custom skincare by Curology

Curology is a full-service skincare service offering products made with proven effective ingredients. Our licensed dermatology providers help take the guesswork out of your skincare routine by determining the products your skin needs. They’ll prescribe a personalized prescription formula to help you tackle skin concerns, including acne, rosacea, and signs of aging. Our formulas can contain active ingredients such as tretinoin, a topical vitamin A derivative, to help you meet your skin goals.

Signing up is easy. Just answer a few questions and snap some selfies to help us get to know your skin better. If Curology is right for you, we’ll pair you with one of our in-house licensed dermatology providers, who will be there throughout your skincare journey to answer any questions you may have.

P.S. We did the homework so you don’t have to:

1. Zaenglein, A., et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. (2016).

2. Acne-like breakouts could be folliculitis. American Academy of Dermatology Association. (n.d.).

3. Acne-like breakouts could be folliculitis. American Academy of Dermatology Association. Ibid.

4. Zaenglein, A., et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. Ibid.

5. Winters, R.D., Mitchell, M. Folliculitis. StatPearls. (2022).

6. Are your hair care products causing breakouts? American Academy of Dermatology Association. Ibid.

7. Acne-like breakouts could be folliculitis. American Academy of Dermatology Association. Ibid.

8. Rubenstein, R.M., Malerich, S.A. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. (2014).

9. Rafi, A. W., & Katz, R. M. Pilot Study of 15 Patients Receiving a New Treatment Regimen for Androgenic Alopecia: The Effects of Atopy on AGA. ISRN dermatology. (2011).

10. Mangion, S.E., et al. Targeted Delivery of Zinc Pyrithione to Skin Epithelia. Int J Mol Sci. (2021).

11. Carson, C.F., et al. Melaleuca alternifolia (Tea Tree) oil: a review of antimicrobial and other medicinal properties. Clin Microbiol Rev. (2006).

12. Lu, J., et al. Salicylic acid treats acne vulgaris by suppressing AMPK/SREBP1 pathway in sebocytes. Exp Dermatol. (2019).

13. Zaenglein, A., et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. Ibid.

14. Anwar, A., et al. Two Percentage of Ketoconazole Cream for the Treatment of Adult Female Acne: A Placebo-Controlled Trial. Cureus. (2020).

Kristen Jokela is a certified Family Nurse Practitioner at Curology. She obtained her Master of Science in Nursing at the University of South Florida in Tampa, FL.

Written by

Curology Team

Medically reviewed by

Kristen Jokela, NP-C