It might not be curable, but treatment can help
By Sherry Christiansen
Updated on April 08, 2023
Medically reviewed by Casey Gallagher, MD
Scalp conditions can cause red spots on the scalp. Many conditions that cause red spots on the scalp cannot be cured, but there are treatments that can help with symptoms (such as itching).
This article will go over the common causes of red spots on the scalp and how they’re treated.
Scalp Psoriasis
Scalp psoriasis is a chronic (long-term) inflammatory condition. Half of the people with psoriasis have it on their scalp, where it can look like red spots or sores.
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Psoriasis is considered an autoimmune disorder because the immune system attacks healthy skin cells, which leads to cells growing faster. Psoriasis tends to run in families (hereditary).1
The symptoms of scalp psoriasis may include:
Small red bumps that grow and form scales
Thick, white, or red plaques covered with silver-gray scales
Itching (which can result in tearing off scales and bleeding from scratching)
Bumpy, red silvery-scaled patches of skin
Scalp lesions and dandruff-like flakes (similar to seborrheic dermatitis)
Extensive loss of hair may occur in severe types of psoriasis
Scalp psoriasis is considered a chronic (long-term) inflammatory disorder. You will usually have times when your psoriasis symptoms go away (remit) and then come back (relapse). It cannot be cured, but there are treatments for scalp psoriasis.
Treatment
Scalp psoriasis can be hard to treat, depending on how severe the condition is.
When a person has mild scalp psoriasis, at-home treatment like over-the-counter (OTC) medicated shampoo may be enough to help with symptoms.
Shampoo with salicylic acid breaks down the scales or plaques from psoriasis, making them easier to remove.
Severe scalp psoriasis can be treated with systemic medications, such as corticosteroids. This means the drug is given by mouth or by injection, and it circulates throughout the entire body.
Treatment of scalp psoriasis also includes avoiding triggers such as:
Alcohol
Stress
Smoking
Infections
Extreme temperatures
Sunlight
Certain medications
Seborrheic Dermatitis
Seborrheic dermatitis is a long-term, inflammatory skin condition that can cause red spots on the scalp.
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Seborrheic dermatitis is most often found in parts of the body that make oil (sebum) in special glands (sebaceous glands). The scalp is a very common area for seborrheic dermatitis because it produces a lot of sebum.
In babies, seborrheic dermatitis is called cradle cap.2
Symptoms of seborrheic dermatitis may include:3
White flake on the scalp
Dandruff-like, itchy white flakes on the scalp
Red scales on the skin
Thick, pinkish plaques on the face
Flaky patches on the chest and hairline
A rash comprised of red spots on the scalp
Greasy yellow scales on the scalp
Yellow crusty powdery flakes on the scalp
Can Seborrheic Dermatitis Cause Hair Loss?
With seborrheic dermatitis, you may have an overgrowth of Malassezia yeast on your scalp.
Untreated, this overgrowth can damage the hair follicles and cause you to lose your hair.4
However, this type of hair loss is treatable and can be reversible.
Treatment
Although there is no cure for seborrheic dermatitis, there are at-home and prescription treatments that can help alleviate symptoms such as inflammation and itching.
Possible treatments for seborrheic dermatitis on the scalp include:
OTC medicated shampoo
Antifungal medications
A calcineurin inhibitor (acts on the immune system to reduce skin inflammation)
Corticosteroids (reduce inflammation)
Ringworm (Tinea Capitis)
Tinea capitis (scalp ringworm) is a type of fungal infection that commonly affects small children and can cause red spots on the scalp. Ringworm often breaks out in schools or daycare centers because kids are in close physical contact.
When ringworm is on the head, it’s called tinea capitis; when it occurs on the skin, the name is tinea corporis.5
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The fungi that cause tinea capitis are very small plant-like organisms that thrive in damp, warm, dark environments.
When fungus grows on the scalp, ringworm can look like a small sore that appears pimple-like.
The affected area gets flaky, patchy, or even scaly. The flakes look like dandruff, but, unlike dandruff, ringworm can cause the hair to break off, forming stubble and leaving a bald spot on the head.
Ringworm makes the scalp look red, and the affected area can be swollen and tender.
Sometimes, ringworm causes a mass filled with pus. Scalp ringworm can also cause swollen lymph nodes at the back of the neck.
Treatment
Some at-home treatments like antifungal sprays, creams, or powders can be enough to treat minor tinea capitis.
When the condition is more severe, you may need a prescription medication that is put on the skin or given orally (by mouth) to treat the fungus systemically (circulating throughout the entire body).
Ringworm on the scalp may need treatment for up to three months. Antifungal shampoo might be recommended by the healthcare provider to prevent the spread of ringworm to others.1
Ringworm Spreads Easily
Ringworm is very contagious. It can be easily spread by sharing personal items or touching a person who has ringworm. Be sure to wash your hands before and after applying the topical medication to prevent spreading it to other parts of the body.6
Ringworm Treatment Options
Folliculitis
Folliculitis is an inflammatory disease of the skin and scalp that can cause red spots.
Folliculitis can show up on parts of the body that have hair and hair follicles, including the head, beard, arms, back, legs, and buttocks.
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Hair follicles are openings with very small pouches in which hair grows and sebum is produced. Folliculitis could be caused by a bacterial, fungal, or parasitic infection.1
The symptoms of folliculitis on the scalp could include:
Reddened, painful, skin
Burning sensation
Pimple-like red spots (with a strand of hair in the center)
Pus may or may not be visible in the red spots
Treatment
Home remedies, such as warm compresses, can often treat mild cases of folliculitis.
Systemic medications such as oral antibiotics or antifungal medication can be prescribed by a healthcare provider if needed.
Acne
Acne is a common skin condition that often affects adolescents, but it can occur at any age.7 Acne can cause red spots on the scalp.
Acne is linked with excess sebum production, clogged hair follicles, and hormones. Acne is also thought to have a genetic link.
Acne on the scalp can be caused by:
Blockage of the follicles (from dead skin cells and sebum)
A buildup of hair products on the scalp (particularly leave-in products such as hair gel and hairspray).
The symptoms of acne are primarily red spots (pimples) that can show up on the face, forehead, chest, upper back, and shoulders. When acne affects the scalp, it can cause symptoms such as:
Pimples on the scalp, the neck, or the back of the head
Soreness or itchiness of affected areas
The pimples occur in the scalp in a blocked pore or hair follicle
Acne comes in several forms, including:
Blackheads: Open, raised bumps, filled with excess sebum and dead skin that appear black in the middle
Whiteheads: Closed raised bumps that contain sebum and dead skin and appear white inside
Papules: Inflamed pink or red bumps
Pustules: Pimples that contain pus
Nodules: Large, deep, painful pimples
Treatment
Scalp acne is usually treated with medicated shampoo or scalp treatments. The shampoo helps to keep sebum at bay, which may prevent acne from recurring. Some types of medicated shampoo can be purchased OTC.7
Head Lice
Head lice is a condition caused by live insects that are approximately the size of a sesame seed. If the insects bite the top of the head, lice can cause red spots on the scalp.
Lice are often difficult to find, but their eggs, called nits, are usually easier to spot. The nits appear as oval-shaped or round globules, stuck to strands of hair; it takes a special type of comb to remove them.1
Lice cause the skin to develop red bumps on the scalp, neck, and shoulders. Symptoms include:
Severe itching
Intense scratching
Sores and scabs
Possible infection (from scratching)
Red bumps (in response to the insect bites that often cause an allergic response)
Dermatitis herpetaformis and head lice.
Reproduced with permission from © DermNet dermnetnz.org 2023.
Treatment
The treatment of lice is very specific. It involves killing the lice and getting rid of nits.
A combination of home treatments and prescription medications can kill lice:
Shampooing with a special medicated shampoo
Removing nits with a special comb
Wash items (such as bed linens and clothing) in hot water to kill the lice.
Refrain from sharing personal items
Placing items that cannot be washed in a sealed plastic bag to kill the lice
Keep in mind that lice are very contagious. Avoid sharing combs, hats, clothing, towels, and other personal items with a person who has lice.
How Head Lice Is Treated
Lichen Planopilaris
Lichen planopilaris is the name for lichen planus that causes permanent scarring, distinct patches of hair loss, redness around the hair follicle, and inflammation on the scalp around hair follicles that are affected by the disorder. You may see red spots on your scalp from lichen planopilaris.
Symptoms of lichen planopilaris may include:8
Smooth white patches of hair loss on the scalp
Absence of hair follicle opening in the area of hair loss
Redness around the hair follicle at the edges that look like red spots
Scales around the affected hair follicles at the edges of the white patches
Hair follicles that feel spiny
Hair that can be pulled out easily
Itching, pain, and burning (though some people do not have these symptoms)
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Treatment
Treatment for lichen planopilaris should be started as early as possible.
Once the hair follicle is scarred, nothing can be done to recover hairs that have been lost. The overall goal of treatment is to slow down the progression of the disorder and to manage symptoms.
Hair loss may continue, even with treatment, but the goal of treatment is to slow it.
Oral medications that have anti-inflammatory properties are given for lichen planopilaris, including:8
Corticosteroids
Methotrexate
Cyclosporine
Other medications
When to See a Healthcare Provider
If you have a condition with red spots on the scalp and home remedies and OTC medications do not work, it’s time to talk with a healthcare provider.
If you have symptoms of infection (possibly from scratching itchy red spots on your scalp), you need medical treatment.
Signs of skin infection include:
Redness
Fluid or pus draining from the affected area
Sores that appear to be blisters
Red spots with a yellowish crust on top
Pain or swelling that worsens (even after home treatment)
A fever
Summary
Red spots on the scalp can be caused by conditions like psoriasis, dermatitis, folliculitis, ringworm, acne, head lice, and lice planopilaris.
To find out for sure why you have red spots on your scalp, see a provider. Once you know what’s causing the red spots on your scalp, you can find the best way to treat them.
You might not be able to get rid of the spots or prevent them from coming back, but many at-home remedies and medical treatments can help with the symptoms.
8 Sources
By Sherry Christiansen
Sherry Christiansen is a medical writer with a healthcare background. She has worked in the hospital setting and collaborated on Alzheimer's research.
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