Red spots on the scalp can occur due to various reasons: inflammatory skin diseases, infections, infestations like lice, or rarely due to skin cancer.
Depending on the cause, the treatment of each will vary. Some of these are chronic conditions that cannot be cured but can be managed with effective treatments.
The different causes of red spots on the scalp and their associated symptoms can be grouped as follows:
- Red spots that are itchy: Head lice, ringworm, eczema, folliculitis, psoriasis, seborrheic dermatitis.
- Red spots that are not itchy: Cherry angiomas, acne (usually does not itch).
- Red spots with flakes: Eczema, psoriasis, seborrheic dermatitis, ringworm.
- Tiny red dots on the scalp: Cherry angiomas, folliculitis, sometimes lice, and acne.
- Painful red spots: Folliculitis, deeper acne cysts, an inflammatory form of ringworm, lichen planopilaris (may be associated with scalp pain).
Below you will find details on the above-mentioned causes of red spots on the scalp, pictures, and their treatment.
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1. Scalp folliculitis
Red spots on the scalp that are painful may be due to folliculitis. Folliculitis is the inflammation or infection of hair follicles. It can present with tender red bumps on the scalp which may be filled with pus (pustules). These can be associated with itching.
Folliculitis is of various types and the underlying cause and presentation can vary in each. Some of the types include:
- Bacterial folliculitis: This is the most common type and is often caused by Staphylococcus aureus.
- Pityrosporum Folliculitis: This is another type caused by the fungus – Malassezia.
- Eosinophilic folliculitis: In this type, eosinophils (which are a type of immune cells) collect around the hair follicles. It is predominantly seen in people with advanced HIV infection.
There are several factors that can increase one’s chance of getting folliculitis. These include – skin barrier disruption, certain medical conditions like diabetes, prolonged use of antibiotics, suppressed immune system, contaminated hot tubs, excessive sweating, and being overweight.
Treatment
The treatment will depend on the severity and type of folliculitis.
- Bacterial folliculitis: The mild cases may resolve on their own. Topical antibiotics like mupirocin may be prescribed in some cases.
- Pityrosporum folliculitis: The treatment includes washing the area with an anti-dandruff shampoo and/or topical or oral antifungals.
- Eosinophilic folliculitis: The treatment may include treating the underlying HIV infection, topical corticosteroids, antihistamines, or phototherapy.
2. Scalp acne
Acne can not only affect the face and body but also the scalp. One can see the red spots of acne along the hairline and the scalp.
Acne is common in teenagers but can occur at any age. Several factors are linked to acne which include excess sebum production, the buildup of dead skin cells, inflammation, and the proliferation of acne-causing bacteria.
Scalp acne can also occur due to hair care products (this is referred to as acne cosmetica).
One can see different types of acne which may include comedones, red bumps, pustules, or painful cystic and nodular acne lesions.
Treatment
- Do not use very oily hair care products.
- Keep your scalp clean by shampooing regularly.
- Wash your scalp after excessive sweating.
- Shampoos containing salicylic acid or sulfur can be helpful.
- If you have active acne lesions, do not pop them.
- If your acne does not improve, it’s best to see a doctor for prescription medications or shampoos.
3. Seborrheic dermatitis
Red patches on the scalp covered with thick yellow scales can be due to seborrheic dermatitis.
Seborrheic dermatitis is a chronic inflammatory skin condition that can present with red spots on the scalp. In people with darker skin tones, it may lead to dark or hypopigmented patches. It may be associated with itching.
In addition to the scalp, seborrheic dermatitis commonly affects the face, ears, and chest.
The exact reason why some people get seborrheic dermatitis is not completely understood. It is thought to be associated with the overgrowth of Malassezia (a fungus that is part of the normal flora of our skin), excessive oiliness, skin barrier defect, some neurological disorders, and medications.
Treatment
Seborrheic dermatitis is a chronic skin condition so it cannot be cured but there are several treatment options to manage this condition.
Over-the-counter anti-dandruff shampoos with antifungals and keratolytic may help in controlling the symptoms. The ingredients to look for are ketoconazole, zinc pyrithione, selenium sulfide, and keratolytic like coal tar and salicylic acid.
If over-the-counter treatments do not work or in severe cases, your doctor may recommend prescription topical antifungals, steroids, or oral medications.
You can find more articles on seborrheic dermatitis here.
4. Scalp psoriasis
Psoriasis is a chronic inflammatory skin condition and is a common cause of red spots on the scalp. Psoriasis is characterized by an increase in cell proliferation resulting in the buildup of skin cells resulting in rough scaly patches.
Psoriasis is of various types and the most common type is plaque psoriasis. It starts as small red bumps which come together to form large raised patches called plaques. These are covered with silvery-white scales. These patches are usually associated with itching.
In addition to the scalp, psoriasis commonly affects elbows, knees, and trunk.
The exact cause is not clear. Genetics, the immune system, and environmental factors are usually associated with it. Any injury, stress, alcohol, smoking, or certain medications can trigger an outbreak of psoriasis.
Treatment
Psoriasis is a chronic condition so it cannot be cured but there are several treatment options that can help in managing it.
Mild cases may be controlled with over-the-counter shampoos and topicals containing coal tar or salicylic acid.
In some cases, your doctor may prescribe topical steroids, immunosuppressants, retinoids, vitamin D derivatives, or phototherapy.
5. Head lice
Red spots on the scalp and back of the head that are itchy can be due to head lice infestation. Head lice are common in young children and are very contagious.
Head lice do not fly but one can get it by head-to-head contact or by sharing hair brushes or combs, caps, pillows, etc.
One may feel a sensation of something crawling especially at night. These are usually associated with intense itching and scratching which can lead to red sores and scabs on the scalp.
One can spot the eggs (called nits) attached to the hair shaft or the adult lice.
Treatment
Head lice can be treated with over-the-counter treatment options like topicals or shampoos with permethrin. In addition, a fine-toothed comb can be helpful in removing them.
One should wash all the clothes and bedding in hot water and soap. The items which cannot be washed should be put in a sealed plastic bag for two weeks. The hair brushes or combs should also be washed in hot soapy water for 10 minutes.
If over-the-counter treatment options don’t work, your doctor may prescribe other topicals or medications like benzyl alcohol lotion, malathion lotion, spinosad suspension, or oral ivermectin
6. Ringworm of the scalp (Tinea capitis)
Red circular spots on the scalp can be due to tinea capitis. Tinea capitis is a contagious fungal infection caused by fungi called dermatophytes. It involves both the scalp and the hair shaft. The hair shaft can become weak and break easily.
The two main types of scalp ringworm are:
- Non-inflammatory type: This can present with areas of scaliness, a gray patch, or black dots on bald patches (where the hair has broken off).
- Inflammatory type: This can lead to painful scalp bumps which are filled with pus called kerion, bald patches, and yellow crusting.
Ringworm of the scalp is commonly seen in children. It can spread by direct contact with ringworm lesions on humans, infected animals, contaminated surfaces, or soil.
Treatment
Over-the-counter topicals cannot completely get rid of the ringworm on the scalp. To treat it, one will need to see a doctor and take prescription oral antifungal medications for 4-12 weeks (examples include griseofulvin and terbinafine).
Your doctor may also recommend washing the scalp with anti-dandruff shampoo to prevent the spread of the fungus.
Early treatment is important to prevent permanent hair loss or other complications.
You can find more articles on ringworm here.
7. Contact dermatitis
Red spots on the scalp can be the result of contact dermatitis. Contact dermatitis is of two types:
- Allergic contact dermatitis: This occurs when our immune system reacts to an allergen or chemical after repeated exposure resulting in itching, dryness, or red spots. The common allergens are hair dyes, hair clips (like those with nickel), hair shampoos, or conditioners.
- Irritant contact dermatitis: This occurs when an irritant like fragrance, essential oils, dyes, or harsh surfactants come in contact with our skin resulting in inflammation, itching, and red spots.
Treatment
In most cases, the red spots may go away on their own. To prevent the worsening of the rash, one should avoid further contact with the allergen or irritant.
A cool compress may help in relieving the itching. In some cases, antihistamines and topical steroids may be prescribed to manage the symptoms.
If there is a secondary infection, your doctor may prescribe antibiotics.
8. Atopic dermatitis
Atopic dermatitis is the most common type of eczema and can cause scalp redness. It can lead to inflammation, dryness, red spots or bumps, oozing, and crusting. It is often associated with itching, which can lead to sores and scabs on the scalp.
The exact cause is not known. Factors that are linked to it include genetics, skin barrier defect, and environmental factors.
Treatment
Mild cases may benefit from gentle scalp care with mild shampoos meant for sensitive skin. Topical steroids, immunosuppressants, and other topicals may be prescribed in some cases.
One should avoid the use of hot water and long showers.
9. Lichen planopilaris
Lichen planopilaris is a form of lichen planus (an inflammatory skin condition) that involves the scalp and hair. It is more often seen in females.
The symptoms may include bald patches on the scalp and redness around hair follicles at the edges of these patches, pain, and a burning sensation. Hair can be easily pulled out as well.
The exact cause of lichen planopilaris is not clear. It may be associated with the immune system.
Treatment
Early treatment is important to prevent or slow down hair loss. Once the hair follicle is scarred, the hair cannot be restored.
Treatment options include topical corticosteroids, immunosuppressants, and antimalarials like hydroxychloroquine. Even with treatment, the hair loss may continue.
10. Cherry angiomas
Bright red spots on the scalp can be cherry angiomas. Cherry angiomas (also called red moles) are non-cancerous skin lesions that can present as flat or raised red spots on the scalp with a smooth surface.
A cherry angioma can appear as a tiny red dot on the scalp or larger, usually up to 5 mm in size.
Cherry angiomas are not itchy or painful, however, they may bleed if traumatized. They are usually seen in adults over the age of 30 years and their incidence increases with age.
Cherry angiomas consist of proliferating small blood vessels called capillaries. The exact cause behind them is not known.
However, they are associated with several factors which include aging, genetics, hormonal changes like pregnancy, exposure to certain medications or chemicals, suppressed immune system, and diabetes.
Treatment
Cherry angiomas are harmless and do not necessarily require treatment. However, if they cause any symptoms or for cosmetic reasons, cherry angiomas can be removed in a doctor’s office by procedures like lasers, cryotherapy, electrodesiccation, or surgical excision.
Read more about cherry angiomas on the scalp here.
11. Skin cancer
A red patch or bump on the scalp can rarely be skin cancer as the head gets frequent sun exposure.
The three main types of skin cancer are:
- Basal cell carcinoma is the most common type of skin cancer. It may present as a non-healing red sore, waxy or shiny bump, flat scaly patch, scar-like area, or a dark lesion.
- Squamous cell carcinoma may present as a red sore with scaly crusting, firm nodule, non-healing sore, or wart-like growth.
- Amelanotic melanoma is a type of melanoma that does not produce melanin pigment. It can present as a red, skin-colored, or pink spot.
Look out for any suspicious signs of skin cancer like a non-healing sore or a red spot with a sudden change in appearance like size, color, or shape.
Skin cancer is diagnosed by a doctor after physical examination and it is usually confirmed with a skin biopsy.
Treatment
The treatment will depend on the type of skin cancer, its size, how deep it invades the skin, and whether the cancer cells have spread to lymph nodes or other organs.
The treatment may include surgical removal, lymph node excision, chemotherapy, or other treatment modalities.
To prevent skin cancer, always use broad-spectrum sunscreen and wear a hat or cap.
When to see a doctor
Over-the-counter treatment options may help in improving the red spots on the scalp, but not in every case. One should see a doctor if:
- The red spots on the scalp are not improving or getting worse.
- They are accompanied by fever.
- There is a visible discharge like pus.
- There is a sudden change in the appearance of the red spots.
- You are not sure what is causing the red spots.
Key points
Red spots on the scalp can occur due to various conditions like acne, folliculitis, ringworm, dermatitis, cherry angiomas, lichen planopilaris, head lice, and rarely due to skin cancer. Treatment of each condition varies so it is important to get the right diagnosis.
Timely treatment is important in conditions like lichen planopilaris, ringworm, and skin cancer to prevent long-term complications.
References
- Lichen planopilaris. Rare diseases. GARD.
- Head lice. American Academy of Dermatology Association.
- Winters RD, Mitchell M. Folliculitis. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Al Aboud AM, Crane JS. Tinea Capitis. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
Disclaimer: This blog post is for information purposes only and does not replace medical advice.