Itchy Scalp & Acne: A Complete Guide to Scalp Health

woman with cute haircut on the street
A healthy scalp is soft to the touch and not too tender or swollen. (Image: Twenty20/@coleito)

People generally care more about hair's appearance than its health: the way it curls, how voluminous it looks, and the type of hairstyle they're rocking. The scalp? Not so much. Yet scalp health is incredibly important, not only for its own sake, but it actually determines how soft and radiant your hair's appearance will be, as well.

"When patients come in concerned about hair loss or hair disorders, the first thing I do is closely examine the scalp," says Pennsylvania-based dermatologist Erum Ilyas. The scalp can show signs of poor health, such as redness, flakiness, or the presence of an itchy scalp. In these cases, a scalp treatment might be necessary in order to reboot your hair's health from the roots themselves, she explains.

A dry and itchy scalp is more common than you think. Here are a few itchy scalp causes, as well as some scalp treatment options that can hydrate and heal for your best hair ever.

What Does a Healthy Scalp Look Like?

A healthy scalp will be soft to the touch, but not too tender or too swollen. It will also have no evidence of redness, scaling, flaking, growths or rashes, Ilyas explains. It will also only have one to just a few hairs growing through each follicular opening, rather than a bunch.

"For example, the 'doll's hair' look to some scalps with tufts of hair growing through one hair follicle can be evidence of chronic inflammation and scar tissue that has blocked healthy hair growth," she says. Not what you're seeing? Here is what could be going on with your scalp.

Why is My Scalp Itching and Flaking?

The most common causes of itchy scalp and flaking tend to be seborrheic dermatitis, psoriasis, and irritant or allergic contact dermatitis.

"Seborrheic dermatitis is thought to be related to an inflammatory response we have to the presence of a yeast on our scalps called Malassezia. It results in dry, flaky, itchy skin on our scalp. Sweating, stress, and temperature changes are common triggers for this condition," says Ilyas.

Psoriasis, a chronic immune mediated or autoimmune skin condition, is estimated to affect about 2-3 percent of the population, says Ilyas, and it can start anytime from childhood through adulthood. "It most often appears as pink scaling patches or plaques," on the scalp, she says. The most common trigger is stress; however, there is no rhyme or reason to the flares.

"Other common triggers are injuries to the skin (psoriasis can often show up in surgical scars), medications can trigger it, infections (strep throat is linked to a particular type of psoriasis called guttate), weather changes, smoking and alcohol use," she says.

Irritant or allergic contact dermatitis to the scalp can result from hair products, styling agents, and hair dyes, so if you are not suffering from the aforementioned conditions, it might be a good idea to re-think the hair products you are using. "Even some active ingredients in hair product, such as tea tree oil, that are added to manage other scalp conditions such as seborrhea can cause allergic reactions," she adds.

If you are seeking treatment options for these conditions, over-the-counter ingredients in shampoos and topical treatments can target inflammation, dryness and scaling in the scalp. "Most of these are meant to be used two to three times weekly to address the underlying triggers of inflammation or to add moisture back to the scalp," Ilyas says.

Zinc pyrthione, an antimicrobial ingredient in many over the counter scalp shampoos or treatments, targets the inflammation-triggering yeast and bacteria on the scalp. Products that contain salicylic acid, tea tree oil, charcoal, coconut oil, and apple cider vinegar are also a good idea for added care. In particular, tea tree oil has been shown to alleviate dandruff and flaky, itchy scalp conditions, according to a study in Journal of the American Academy of Dermatology.

Hair stylist and Supercuts national artistic director Brittany Perry recommends Paul Mitchell's tea tree hair and scalp treatment, or Nioxin's complete line of scalp therapy products, normally used as a system.

man with man bun poses against wall
Paul Mitchell and Nioxin both offer effective products against flaking scalp. (Image: Twenty20/@Aptcore)

Why Does My Scalp Get Acne?

According to Ilyas, scalp acne is generally triggered by clogged pores or blocked follicles that trigger inflammation in the scalp.

For less severe cases of scalp acne, stylist Perry recommends astringent or tea tree oil. More severe cases can be treated through oral medications, such as isotreinoin, antibiotics or steroid injections into the scalp.

"This is a deep process at the root of the follicle and topicals simply cannot effectively manage it," Ilyas explains. So, if you find pimples popping up on your scalp, see a dermatologist for an expert's opinion on how to diagnose and handle the outbreaks.

Why Does My Scalp Get Folliculitis?

There are multiple triggers for folliculitis of the scalp. "Most cases of breakouts in the scalp are actually folliculitis. The difference is that the trigger is not necessarily clogged pores or comedones that trigger acne. The trigger is more commonly inflammation at the base of the hair follicles, [which] can be the result of bacteria, yeast, mites and/or autoimmune triggers," says Ilyas.

Causes of itchy scalp from folliculitis are heat, sweating, humidity, hormonal changes, and conditions that alter the pH of the skin to permit the overgrowth of yeast, bacteria, and mites, she explains.

Scalp treatments for folliculitis include shampoos containing zinc pyrithione, as this ingredient has had proven antimicrobial qualities, says Ilyas, as well as selenium sulfide based shampoos.

"Selenium sulfide has been shown to be both antimicrobial and an effective treatment for hyperkeratosis or thickening of the skin," she says. "By addressing the buildup and the yeast and bacteria that contribute to scalp acne, this is a safe and effective approach to this common problem," she says.

You should definitely speak to a dermatologist to figure would which type of folliculitis you have. "If there is an autoimmune component or significant inflammatory component, topical steroids or injections of steroids into the scalp may be necessary to control these conditions more effectively and avoid scarring that can result in permanent hair loss," she says.

woman flipping hair outdoors
Treat your sensitive scalp at home with a hydrating hair mask that combines coconut oil, argan oil and shea butter. (Image: Twenty20/@dashapats)

How Can I Treat a Sensitive Scalp at Home?

Firstly, there are a few factors that contribute to a sensitive scalp: altered pH levels, overgrowth of certain bacteria and excess oil or sebum production.

To tackle these, a good hair mask comes into play. "Coconut oil, argan oil and shea butter are good ingredients to help re-hydrate the scalp and reduce itching and scaling," says Ilyas.

Tip

Try this mask: Melt two tablespoons of coconut oil with one tablespoon of shea butter in a microwave safe dish. Mix in one teaspoon of argan oil.

Peanut oil might also help. "Peanut oil has been used in a prescription product for psoriasis for years. It has vitamin E, antioxidants and moisturizing properties," says Ilyas.

Tip

Try this mask: Use four tablespoons of peanut oil and mix with several drops of lemon juice before applying to the scalp.

In addition, avoid sulfate products. "Sulfate can cause drying which in turn can irritate the scalp," says Perry. "It's a 10 Miracle Mask has a wonderful mask that helps to soothe the scalp after shampooing, that can be used every other week. Also a homemade coconut oil, olive oil, and lavender oil mask can soothe a sensitive scalp," she adds.

What Are the Best Products for an Itchy Scalp?

Any shampoo with natural ingredients, such as tea tree oil, coconut oil, lavender oil and other essential oils can help soothe the scalp, says Perry.

Free and Clear shampoo and conditioner is free of fragrance and many preservatives that might be linked to allergies and contact dermatitis, so Ilyas recommends this to her patients. She also recommends DHS shampoo and conditioner.

Good leave-in formula options are EverPure 10-in-1 Elixir (which promises to restore hydration after washing) and Briogeo's Don't Despair, Repair! mask.

Dealing with scalp issues is never fun, but with a little help from antibiotics, at-home masks or store bought products, you'll be on your way to hair that's happy and healthy. For best results in determining how to tackle your issues, see a dermatologist.

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