Scabs and sores on the scalp can occur for various reasons – intense itching, scalp injury, inflammatory skin conditions, infectious rashes, and, rarely skin cancer.
Chronic skin conditions can sometimes cause a recurring scab on the scalp in the same spot. Picking at these scabs can delay the healing process and may result in bleeding, infection, or scarring.
Some scalp scabs can be treated at home; however, others require prescription medications or other treatments. In some cases, your doctor may perform additional tests to confirm the diagnosis.
Any non-healing scab or sore on the scalp should be examined by a doctor for appropriate management.
Table of Contents
What is a scab?
A scab is a protective covering over damaged or injured skin that is formed from components of blood.
It is dry and rough, and usually dark red or reddish brown in color (it may get darker or lose color over time in some people). The scab may appear yellow or white when moist or if they are covered by any fluid or discharge.
Scabs protect the underlying skin from infection and help it to heal. Picking the scab can lead to infections and delay the healing process. So, it is important to leave them alone. The underlying cause should be identified and treated.
Below you will find 17 skin conditions or causes that can lead to scabs and sores on the scalp, their pictures, and treatment.
1. Dandruff
Dandruff is a very common scalp condition that causes itchiness and flakiness. Dandruff flakes are layers of dead skin cells and are typically white or yellow in color. Scratching these can lead to scabs and sores on the scalp, although dandruff itself does not cause scabs.
Cause
The exact cause of dandruff is not clear. Malassezia (a yeast that normally lives on our skin), excessive oiliness and skin barrier dysfunction may play a role. Dandruff is not a hygiene issue nor is it contagious.
Treatment
Dandruff can be treated with over-the-counter available anti-dandruff shampoos. The ingredients to look for are:
- Zinc pyrithione
- Ketoconazole (1%)
- Sulfur
- Selenium sulfide
- Coal tar
- Salicylic acid
Make sure to leave the foam on the scalp for a few minutes so that the ingredients can work or follow the instructions of the packaging of the product.
Shampoo regularly to prevent the buildup of oils and dead skin cells. If over-the-counter shampoos don’t work, your doctor may prescribe prescription-strength ketoconazole shampoo or other medications.
2. Seborrheic dermatitis
Seborrheic dermatitis (also known as seborrheic eczema) is a chronic inflammatory skin condition that results in scalp redness and patches covered with thick, yellow crusty scales. Scratching these spots can lead to scabs and sores on the scalp.
In addition to the scalp, seborrheic dermatitis can also affect the face, ears, or chest.
Cause
Just like dandruff, the exact cause is not clear. Malassezia, excessive oiliness, skin barrier defect, some neurological disorders, and medications may play a role in it.
Treatment
Over-the-counter anti-dandruff shampoos may help in controlling the symptoms. Antifungals like ketoconazole, zinc pyrithione, selenium sulfide, and keratolytic like coal tar and salicylic acid can help improve the crusty spots on the scalp.
In severe cases, your doctor may recommend prescription topical antifungals, steroids, or oral medications.
Seborrheic dermatitis cannot be cured, but with the right treatment, the symptoms can be managed.
You can find more articles on seborrheic dermatitis here.
3. Scalp psoriasis
Psoriasis is a chronic inflammatory skin condition and it is of various types. Plaque psoriasis is the most common type. It can lead to red bumps and plaques which are covered with silvery white scales.
The commonly affected areas are the scalp, elbows, knees, and trunk. It is usually associated with itching.
Under the microscope, areas affected by psoriasis show supra-papillary thinning. In simple words, the top layer of skin is thinned out in a few places.
So, scratching or removing the white scales can lead to bleeding, sores, and scabs on the scalp.
Cause
The exact cause is not clear. Genetics, the immune system, and environmental factors are usually associated with it. Any injury or stress can lead to an outbreak of psoriasis.
Treatment
The treatment options include over-the-counter shampoos and topicals containing coal tar or salicylic acid.
In some cases, your doctor may recommend topical steroids, immunosuppressants, vitamin D or A derivatives, and phototherapy.
4. Head lice
Itchy sores and scabs on the scalp can be associated with head lice. Head lice are small insects that live on the scalp and feed on human blood. One may feel a sensation of something crawling or experience intense itching. Itching and scratching can lead to sores and scabs on the scalp.
Head lice don’t fly, but one can get it after head-to-head contact. They can crawl from one area to another. One can also get them from any objects that come in contact with the head of someone with head lice-like caps. One can spot them in hair – either the adult lice or their eggs.
It is very commonly seen in children. As per the American Academy of Dermatology Association, it affects 6-12 million children (between the ages of 3 to 12) each year in the U.S.
Treatment
There are several over-the-counter treatment options with ingredients like permethrin which can get rid of head lice. In addition, a fine-toothed comb can help in removing them.
If over-the-counter treatment options don’t work, your doctor may prescribe:
- Benzyl alcohol lotion
- Malathion lotion
- Spinosad suspension
- Oral ivermectin
Additional measures to follow:
- Wash all the clothes and bedding with soap and hot water and dry them in a hot dryer.
- The objects or items which cannot be washed, should be sealed in a plastic bag for two weeks.
- Combs and brushes should be soaked in soapy hot water for at least 10 minutes.
5. Scalp acne
Scalp acne refers to acne breakouts on the scalp and along the hairline. Scalp is rich in oil glands so it is not uncommon to see scalp acne.
In addition, the buildup of dead skin cells, inflammation, and proliferation of acne-causing bacteria can lead to acne.
They can be comedones, red bumps, pustules, or painful cystic and nodular acne lesions. Popping the acne breakouts can lead to scabs and sores on the scalp.
Scalp acne can be often triggered by hair care products. This is called acne cosmetica.
Treatment
- Do not pop the acne lesions.
- Keep your scalp clean and when shampooing concentrate on the scalp instead of the hair.
- Use shampoos based on salicylic acid or sulfur.
- Wash your hair after excessive sweating.
- Avoid the use of excessively oily hair care products.
- If your acne gets worse or does not improve, you should see a doctor for prescription retinoids and topical or oral antibiotics.
6. Scalp folliculitis
Scalp with scabs and painful sores can be the result of intense itching associated with folliculitis.
Folliculitis is the inflammation or infection of hair follicles. It can lead to painful and itchy red bumps on the scalp which may be filled with pus (called pustules).
Cause
There are various types of folliculitis. Bacterial folliculitis is the most common type and is often caused by Staphylococcus aureus.
Pityrosporum folliculitis is another type caused by the fungus – Malassezia.
Eosinophilic folliculitis is a type in which eosinophils collect around the hair follicles. Eosinophils are a type of immune cell. This is a rare type found predominantly in people with advanced HIV infection.
Few factors can increase one’s chance of getting folliculitis. These include – any disruption of the skin barrier, suppressed immune system, prolonged antibiotic use, contaminated hot tubs, certain medical conditions like diabetes, and excessive sweating.
Treatment
- Mild cases of bacterial folliculitis may resolve on their own. Topical antibiotics like mupirocin may be prescribed in some cases.
- Malassezia folliculitis treatment includes washing the area with an anti-dandruff shampoo and/or topical or oral antifungals.
- Eosinophilic folliculitis treatment may include treating the underlying HIV infection. topical corticosteroids, antihistamines, or phototherapy.
7. Chickenpox
Scalp blisters which may scab as they heal can occur due to infections like chickenpox.
Chickenpox is a viral infection that leads to itchy fluid-filled bumps on the skin which undergo scabbing as they heal. Scratching can lead to sores and secondary infections.
The rash may involve the whole body, particularly the face, scalp, and trunk. It lasts for around 2 weeks and one may have other symptoms like fever, fatigue, and headache.
Cause
It is caused by a type of herpes virus called the Varicella-zoster virus. One can get this virus by coming in close contact with someone else with chickenpox or contaminated surfaces.
Treatment
The treatment is often symptomatic with medications to reduce fever. In some people, antiviral medication may be prescribed.
8. Shingles
Shingles can lead to a rash with painful fluid-filled sores called blisters on the scalp. It appears on one side of the body like the left side of the scalp.
The rash is usually preceded by itching or burning sensation followed by red bumps which form blisters. These blisters undergo crusting and scabbing.
It may be accompanied by other systemic symptoms like fever or fatigue.
Cause
It occurs due to the Varicella-zoster virus – the same virus which causes chickenpox. Once a person gets chickenpox, this virus stays in the body for life.
It can reactivate decades later in some people. An outbreak can occur due to stress, underlying medical conditions like diabetes or cancer, some medications, or weakened immune systems.
One cannot spread shingles but one can spread the virus to people who never had chickenpox or vaccination against it. In such people, the virus can cause chickenpox.
Treatment
Your doctor may prescribe antiviral medications which can help in faster healing of the skin lesions.
It can also prevent complications like postherpetic neuralgia (which is persistent pain even after the lesions heal completely).
In some cases, medications to reduce pain like gabapentin or amitriptyline may also be prescribed.
Shingles can be prevented by the Shingrix vaccine.
9. Ringworm of the scalp (Tinea capitis)
Tinea capitis is a contagious fungal infection that is commonly seen in children. It involves both the scalp and the hair shaft. It can make the hair shaft weak and it can break easily.
Tinea capitis can be divided into two types and both of these can present with different scalp lesions:
- Non-inflammatory type: It can present with areas of scaliness, a gray patch, or patches with black dots.
- Inflammatory type: It can lead to painful scalp bumps which are filled with pus (kerion), yellow crusting, and areas of hair loss.
Cause
Ringworm is caused by fungi called dermatophytes. One can get it by direct contact with ringworm lesions, infected animals, contaminated surfaces, or soil.
Treatment
Ringworm of the scalp cannot be treated with over-the-counter topicals. One will need to see a doctor and take oral antifungal medications for 4-12 weeks (examples include Griseofulvin and terbinafine).
In addition, your doctor may recommend the use of anti-dandruff shampoo to prevent the spread of the fungus. Early treatment is important to prevent complications like permanent hair loss.
10. Atopic dermatitis
Atopic dermatitis is the most common type of eczema. It can lead to inflammation, red spots or bumps, dryness, oozing, and crusting. It’s usually associated with itching which can lead to scabs, sores, or secondary infection.
Cause
The exact cause is not clear. Genetics, skin barrier dysfunction, environmental factors, and altered skin microbiome may play a role in it.
Treatment
Gentle scalp care with mild shampoos can be beneficial. Avoid the use of very hot water and long baths. Topical steroids, calcineurin inhibitors, or other topicals may be prescribed in some cases.
11. Contact dermatitis
Contact dermatitis can lead to a red and itchy rash on the scalp. Scratching the area can lead to breaks in the skin, leading to sores and scab formation.
Cause
It can occur if the scalp comes in contact with an allergen or irritant like fragrance, essential oils, dyes, or harsh surfactants. These can be found in shampoos, hair styling products, or hair dyes.
The other potential irritants or allergens are poison ivy, jewelry or hairpins, pollens, or molds.
Treatment
In most cases, the rash will resolve on its own. One should avoid further contact with the allergen or irritant.
Cool compress, antihistamines, and topical steroids may help in decreasing the symptoms. If there is a secondary infection, your doctor may prescribe antibiotics.
12. Lichen planopilaris
Lichen planopilaris is an inflammatory skin condition that involves the scalp and hair. It is more often seen in females.
It can lead to red painful sores on the scalp which may itch. It may cause scarring and permanent hair loss.
Cause
The exact cause is not clear. It may be associated with our immune system.
Treatment
Early treatment is important to prevent or slow permanent hair loss. Treatment options include topical corticosteroids, antimalarials like hydroxychloroquine, and systemic immunosuppressants.
13. Cutaneous lupus
Cutaneous lupus is a group of disorders that affect the skin and is commonly seen in females between the ages of 20-50 years. It is of 3 main types:
- Acute cutaneous lupus presents with a red malar rash involving the cheeks and nose (butterfly pattern).
- Subacute cutaneous lupus presents with red and scaly circular spots on the skin, commonly on the sun-exposed areas like the upper arms or trunk.
- Chronic cutaneous lupus: The most common form is discoid lupus erythematosus. It is commonly seen on the scalp, ears, cheeks, nose, and lips. It can lead to red scaly plaques, scarring, and hair loss.
Cause
It is thought to be associated with our immune system, genetics, and environmental factors. Sun exposure can exacerbate cutaneous lupus.
Treatment
The treatment may include topical or oral steroids, antimalarials, or immunomodulators. One should avoid smoking and protect the skin from the sun.
14. Dermatitis herpetiformis
Dermatitis herpetiformis is a chronic skin condition that is commonly seen in people with celiac disease.
It can lead to red bumps which can form blisters. The rash may be preceded by a burning sensation. The rash is very itchy and the skin lesions are often scratched. This can lead to erosions, sores, and scab formation.
It commonly involves the scalp, knees, elbows, shoulders, or buttocks.
It has no connection to herpes virus but the rash can look like a rash caused by herpes virus.
Cause
It occurs due to sensitivity to gluten in some people. Eating foods with gluten like wheat, barley or rye can release IgA antibodies in our bodies. These antibodies can deposit in the skin leading to this itchy blister rash.
Treatment
Your doctor may prescribe Dapsone, an oral antibiotic, which can improve the rash. In addition, one should follow a strict gluten-free diet.
15. Scalp injury
Any physical injury to the head like a cut, scratch, or scrape can lead to bleeding and scab formation on the scalp.
Treatment
Minor scalp wounds or cuts may be treated at home while deeper cuts will require medical treatment.
In addition, see a doctor if the area becomes very painful or there is pus or foul-smelling discharge. These may be signs of infection of the wound.
16. After a hair transplant
Scalp scabs are a part of the normal healing process after a hair transplant.
You should follow all the instructions given by your doctor when taking care of the treated area. It may take some time for all the scabs to clear.
They might recommend certain shampoos to wash the affected area. Follow good hand hygiene to prevent infection of the treated area.
17. Skin cancer
Skin cancer is commonly seen in sun-exposed areas like the scalp, face, ears, or neck. The three main types of skin cancer are:
- Basal cell carcinoma may present as an open sore, waxy or shiny bump, flat scaly patch, scar-like area, or a dark lesion.
- Squamous cell carcinoma may present as a bump with scaly crusting, firm nodule, non-healing ulcer, or wart-like growth.
- Melanoma may present as an asymmetrical pigmented lesion with an irregular border.
Look out for suspicious signs like:
- A scalp scab or sore that does not heal.
- There is a change in color or shape.
- A sudden increase in size.
The diagnosis of skin cancer is made by a doctor. They may do a skin biopsy to confirm the diagnosis
Treatment
The treatment will depend on the type of cancer, size, depth of invasion, and whether the cancer cells have spread to lymph nodes or other organs.
The treatment may include surgical excision, lymph node removal, chemotherapy, or other treatment modalities.
To prevent skin cancer, protect your scalp by using a hat or cap and use a broad-spectrum sunscreen spray or lotion.
Precautions
- Practice good hand hygiene, to prevent the spread of infectious scalp lesions.
- Keep your scalp clean and limit the use of hair styling products.
- Scalp scabs are a protective covering, so don’t try to remove them.
- Follow all the instructions given by your healthcare provider or on the packaging, when using any topical for treatment.
- Keep your fingernails trimmed.
- If the scalp scabs and sores are not improving or you are not sure what is causing them, it’s best to see a doctor.
Key points
Scabs and sores on the scalp can occur for various reasons, such as infections like ringworm, inflammatory or allergic skin conditions like contact dermatitis, and, rarely skin cancer.
A newly formed scalp scab may appear red, and over time, it may become reddish-brown or it may lose color, turning yellowish or white. Sometimes, the scab may be covered with fluid or discharge, making it appear as white scabs on the scalp.
It’s important not to pick at the scab and to treat the underlying cause. If over-the-counter shampoos or other remedies haven’t provided relief, and the scabs and sores keep recurring or are extremely painful, it’s best to see a doctor. Timely diagnosis and treatment can prevent complications.
References
- Lepe K, Nassereddin A, Salazar FJ. Lichen Planopilaris. [Updated 2022 Nov 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Head lice. American Academy of Dermatology Association.
- Scalp eczema. National eczema Society.
- 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.
- Dermatitis Herpetiformis. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Disclaimer: This blog post is for information purposes only and does not replace medical advice.