What Causes Those Bumps on Our Scalp?
When you think about the health of your scalp, most of the time you're probably focused on your hair. However, it turns out there's a lot going on with the skin underneath your hair. So, in addition to frizziness or hair loss, you could be facing dandruff or bumps on your scalp, too. The good news is that if your scalp is healthy, you'll have a better chance of growing healthy hair, according to evidence from the National Institutes of Health. When the scalp is unhealthy, it can do the opposite. When something in your scalp goes awry, it can lead to uncomfortable rashes, bumps, flakes, sores, scabs and even hair loss.
The Anatomy of the Scalp
The skin on the scalp is different than that on the rest of the body:
Besides the obvious profusion of hair follicles, the scalp has more
sebaceous glands — tiny glands found in hair follicles (and some
hairless parts of the body as well) that release sebum, an oily
substance that acts as a lubricant for hair and skin. All of this makes
the scalp a particularly rich environment for microbes, which can bring
on various problems — including some that require medical attention.
If you're dealing with itchy, unsightly or
just plain annoying scalp issues, use the info below to help figure out
if one of these common scalp conditions could be the root cause. Once
you know what's going on, you can better treat the underlying condition.
Since it's nearly impossible to get a good look at the top or back of
your own head, it's a great idea to have a board-certified dermatologist
examine your scalp and come up with a treatment plan to help you find
relief.
Head Lice
These tiny insects live in the hair on people's heads (including
eyebrows and eyelashes!) and feed on human blood. While they don't
spread any diseases and they can't jump or fly, lice can crawl from one
person to another if they touch, according to the Centers for Disease
Control and Prevention (CDC). When a person is allergic to a lice bite,
it can itch.
What it looks like:
Lice eggs (nits) are usually attached to the hair shaft and may be
confused with scabs or dandruff flakes. Adult lice are about the size of
a sesame seed and tan or gray in color; they may appear darker on
darker hair. There may be sores on the scalp if the person has been
scratching.
The causes: Usually lice are spread when one person's head touches
another person's. Young kids are the biggest culprits, but it's
important to note that a lice infestation does not mean a person is
dirty.
It's also possible — but not likely — to get lice from shared items like
clothes, pillows or combs.
The treatments: Head lice can usually be
taken care of with an OTC shampoo treatment and a lice comb.
If that doesn't work, a doctor can prescribe additional medications. You
should also vacuum, wash the infected person's clothes and bedding and
disinfect their combs and brushes, according to the CDC.
Lichen Planus
Lichen planus (LP) is an inflammatory disorder that affects the skin and
mucus membranes. Research shows it's common and can show up nearly
anywhere on the body. This includes the mouth, genitals, nails, legs and
the scalp (just to name a few spots!).
What it looks like:
LP usually appears as small purple or red irritated bumps on the scalp
and in some cases, it can cause hair loss. On other parts of the body,
it may manifest in a different way, according to the American Academy of
Dermatology (AAD).
The causes:
No one is exactly sure what causes a person to develop LP,
but the AAD says these are some likely triggers:
1. In rare instances, metal dental fillings have been linked with LP.
2. People with Hepatitis C are more likely to have LP.
3. Certain medications seem to spark the development of LP so tell your
dermatologist about everything that you take.
4. Genetics may also come into play — one particular type of LP called
bullous lichen planus tends to run in families.
The treatments:
1.Topicals like
corticosteroid, retinoic acid, tacrolimus ointment and pimecrolimus
cream can be applied to skin where there are LP lesions.
2. Antihistamines and retinoic acid can be taken in pill form.
3. Using PUVA therapy, patients either soak parts of their skin in water
that contains psoralens (plant compounds that make skin more sensitive
to UVA rays) or they take psoralens orally. Then, affected skin is
exposed to ultraviolet A (UVA) light.
Seborrheic Dermatitis (Dandruff)
Seb derm, as most dermatologists call it, is one of the most common
scalp conditions. In babies, it's called cradle cap; in adults, it
causes red, itchy patches with greasy scales or flakes. People usually
refer to it as dandruff when it's on the scalp, but seb derm when it
affects the face, nose, eyebrows, ears or chest. Research estimates that
half of all adults in the world have dandruff so if you're struggling
with it you're definitely not alone. Seb derm often comes and goes with
triggers such as stress and seasonal changes — it is usually worse in
winter and early spring. It's often best to treat seborrheic dermatitis
early and aggressively to avoid complications such as hair loss.
What it looks like:
Greasy scales and dandruff flakes
The causes:
1. A yeast (fungus) called malassezia, which is in the oil
secretion on the skin, is thought to be the culprit, though doctors
don't know for sure.
2. Parkinson's disease, depression, diabetes, a weakened immune system
and obesity may make a person more likely to have seb derm. So can
recovering from a stressful health event, like a heart attack.
3. Dry skin can result in flakes as can a sensitivity to certain hair
products so it's helpful to look at your scalp care regimen to see if
something other than a fungus is causing your flakes.
The treatments:
1. A prescription strength
anti-yeast shampoo called ketoconazole can help. Since it can be very
drying to the hair, applying the shampoo directly to your scalp 5 to 10
minutes before wetting the hair and then lathering only the scalp area
before you rinse it off is recommended. Following with a moisturizing
shampoo and conditioner on the hair shaft can prevent the dryness that
prescription shampoos can often cause, especially in more coily hair
types.
2. OTC shampoos or lotions that contain zinc pyrithione, ketoconazole or
sulfur may also help.
3. A topical steroid may be prescribed if the shampoo doesn't work, or
in combination with the shampoo if the scales are very dense.
Psoriasis
This condition affects about 1 to 2% of the general population and
anyone can get it, at any age. Psoriasis can appear on any part of the
body, but according to the National Psoriasis Foundation, as many as 45%
to 56% of those with psoriasis have it on their scalp. And that kind is
one of the most difficult types to treat. One way to distinguish it
from dandruff: The buildup of skin cells creates scaly patches that are
dry, rather than oily. And those patches can itch, hurt, crust up and
bleed.
What it looks like:
Pink plaques with a silvery scale. On darker skin tones, the plaques may
be dark red or purplish.
The causes: 1. Psoriasis is thought to be an immune dysregulation around
skin cells that causes the cells in the top layer of skin to go into
overdrive.
2. Stress can make the situation worse, because it causes an increase in
the hormone cortisol, which in turn can boost inflammation.
The treatments:
1. Topical steroids, which control the inflammatory response, are the
most common treatment.
2. Injections called biologics that help suppress what's causing the
flare-ups in tougher cases.
3. An excimer laser can work on individual spots that haven't responded
to other therapies.
4. A gentler hair routine can also help. Not shampooing your hair every
day may lessen the number of skin rashes, or a therapeutic oil cream can
do wonders.
Folliculitis
Folliculitis, a common skin condition, is basically inflammation of the
hair follicle; it appears as little pus bumps scattered throughout the
scalp that look similar to acne and can spread. The bumps can sometimes
feel sore.
What it looks like:
Scattered pus bumps. On darker skin tones, the bumps may be a dark shade of red or light purple around the periphery.
The causes: 1. Bacteria (most commonly a staph infection) or a fungal infection.
2. Irritation from shaving, heavy conditioners, potent hair dyes and excessive sweating.
The treatments:
1. Topical or oral
antibiotics may be prescribed if your doctor determines via a culture
that bacteria is causing your scalp woes.
2. Anti-inflammatory medications, such as topical steroid formulations,
can be effective if there isn't an infectious agent present.
Hair Loss
Hair loss can be due to a number of different factors, including
genetics, medications, inflammation, hormonal abnormalities and hair
fragility. Regardless of the cause of hair loss, it can be extremely
distressing. If you notice your hair breaking or shedding, or you see
bald spots on your scalp, make an appointment to get evaluated by a
health care provider immediately.
What it looks like:
Anything from hair breaking or shedding, to bald spots on your scalp.
The causes:
1. Anemia, vitamin deficiency, thyroid abnormalities,
irregular hormone levels (especially after pregnancy) and autoimmune
markers can all lead to hair loss.
2. Extreme stress, such as the death of a loved one, can have an impact
on your whole body including your hair.
3. Major weight loss (sometimes related to a high-protein diet) can also
trigger hair loss.
4. Infection and illness can cause a massive shedding months after the
incident — a condition called telogen effluvium. For instance, a survey
conducted by Survivor Corps found that nearly 68% of 1,700 COVID-19
survivors that were interviewed reported experiencing hair loss in the
wake of their coronavirus infection.
Age can also play a role: As estrogen levels decrease between
childbearing age and menopause, our hair may thin out. Years of
bleaching, dyeing, straightening, perming and rocking tight,
slicked-back hairstyles can also catch up to us.
The treatments:
1. Rogaine, a solution that
thickens existing hair, and spironolactone, a pill that helps block
hormones called androgens, can be helpful in cases of hormonal thinning.
2. Eating a well-balanced diet is also useful when experiencing hair
health woes, and talking to your doctor about whether you're deficient
in iron or specific vitamins.
3. Taking a break from over-processing your hair and wearing more
natural styles is recommended.
4. Platelet-rich plasma (PRP) is an effective option for androgenetic
alopecia (also called male and female pattern hair loss) and the
residual thinning after telogen effluvium. During PRP, a patient's blood
is drawn and the plasma, which is rich in various growth factors
effective for stimulating hair regrowth, is isolated and injected or
applied to the scalp with microneedling.
Cysts
Cysts can occur on the skin, just like they can show up on other organs.
The good news: Scalp cysts are common and easy to identify. They are
usually bumps the size of marbles or grapes, and you can feel them when
your comb or brush runs over them. If you're unsure about a bump or you
can't get a good look at your scalp, that's a smart time to consult a
dermatologist.
What it looks like:
A skin-colored or pink-red smooth bump
The cause:
For the most part, scalp cysts are mostly genetic.
The treatments:
1. Leave them alone. This is definitely an easy option
if the scalp cysts aren't bothering you, since they are mostly benign
and shouldn't raise any concern.
2. Have them drained: In some cases, however, scalp cysts can get
infected or irritated, which causes pain. Incision and drainage can help
calm the symptoms, but won't remove the cyst in its entirety.
3. Consider antibiotics: These can also help relieve symptoms of an
inflamed or infected cyst.
4. Have them surgically removed by a medical professional. Cysts contain
a fluid-filled sac. Unless the sac is removed, the cyst can recur, thus
surgery is the only effective option to completely remove a cyst and
make sure it doesn't recur. But the surgical removal is very simple and
done with just a local anesthetic. While it does leave a scar, it's
often not noticeable on the scalp since it's hidden by hair.
Ringworm
Also called tinea capitis, ringworm is a contagious fungal infection
that usually happens in little kids, but occasionally infects adults
too. Despite the name, no worm is involved: The condition got its name
from its circular shape. The rash is usually painful and scaly and
sometimes causes enlarged lymph nodes. It also can lead to bald spots,
broken hairs and black dots on the skin.
What it looks like:
Scaly rash and bald spots
The cause:
According to the Mayo Clinic,
ringworm can be spread human to human, animal to human (cats are a
common source) and object (like clothing, towels, bedding, combs and
brushes) to human. Ringworm can also be transferred by indirect contact
through a swimming pool or hot tub.
The treatment: Anti-fungal medication taken daily for 4 to 6 weeks
usually eliminates ringworm. Ringworm is no longer contagious 48 hours
after starting treatment. Until then, you want to avoid contact with
others, as tinea capitis can spread through contact with other areas of
the body and other people.
Allergic Contact Dermatitis (ACD)
This rash is a reaction to the scalp coming
into direct contact with an allergen that results in a response from
the immune system — sometimes days after the contact, so it can be
difficult to determine what the body is reacting to. ACD can be painful,
itchy and even oozing in some cases. The symptoms of a severe case can
often be mistaken for infection.
What it looks like:
Itchy redness. On darker skin tones, it may look pink, grayish or
purple.
The causes:
1. Paraphenylenediamine (PPD) is a chemical that is widely
used as a permanent hair dye and it can wreak havoc on the skin and is
one of the most common causes of scalp allergic contact dermatitis.
2. The chemicals/fragrances in shampoos and conditioners are also a
common cause of ACD.
3. Other relevant possible allergens include propylene glycol,
Cocamidopropyl betaine, methylisothiazolinone (MI) or a combined
formulation of methylchloroisothiazolinone and MI.
The treatments:
1. Identifying the trigger and eliminating it. As
stated, that can be difficult to determine; sometimes a patch test is
needed to figure out what the body is allergic to.
2. Topical steroid gel, foam, cream or ointment: Two to three weeks of
treatment should help decrease inflammation and clear up your skin.
3. Systemic steroids may be prescribed in severe cases - consult your
doctor.
In Conclusion...
Understanding the various conditions that can affect your scalp is an
important step toward maintaining both scalp and hair health. From
common issues like dandruff and folliculitis to more complex conditions
such as psoriasis and lichen planus, each scalp condition has distinct
characteristics, causes, and treatment options. The key to effective
management lies in proper identification and timely intervention.
While some scalp conditions can be treated with over-the-counter
products and lifestyle modifications, others require professional
medical attention and prescription treatments. If you're experiencing
persistent itching, unusual bumps, significant flaking, hair loss, or
any other concerning symptoms, don't hesitate to consult a
board-certified dermatologist. Early diagnosis and treatment can prevent
complications and often lead to better outcomes.
Remember that a healthy scalp is the foundation for healthy hair growth.
Simple practices like maintaining good hygiene, avoiding harsh
chemicals when possible, managing stress levels, and being mindful of
potential allergens in your hair care products can go a long way in
preventing many scalp issues. Additionally, if you notice any changes in
your scalp health or if symptoms persist despite treatment, seeking
professional evaluation is always the wisest course of action.
Your scalp deserves the same attention and care as the rest of your
skin. By staying informed about these common conditions and their
treatments, you're better equipped to recognize problems early and take
appropriate action. Whether dealing with a minor irritation or a more
serious condition, proper care and medical guidance can help restore
your scalp to optimal health.