Potential Causes of Red Spots on Your Scalp and How to Treat Them

Numerous scalp conditions can cause red spots on the scalp. Many of these cannot be cured, but some treatments can alleviate some of the symptoms (such as itching). The treatment of red spots on the scalp differs, depending on the underlying causes, which are outlined in this article.

person checking scalp

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Scalp Psoriasis

Scalp psoriasis is a chronic (long-term) inflammatory condition that involves periods of remission (when symptoms go away) and relapse.

Half of those with psoriasis will have scalp involvement. Psoriasis is considered an autoimmune disorder, meaning that the immune system attacks healthy skin cells, the result is rapid cell growth.

Psoriasis tends to be hereditary.

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

The condition is considered a chronic (long-term) inflammatory disorder. It cannot be cured and involves remissions (when symptoms go away) and relapse (when symptoms come back).

Treatment

Scalp psoriasis is considered a condition that is not easy to treat.

When a person has mild scalp psoriasis, over-the-counter medicated shampoo may be enough to help reduce symptoms. Shampoo with salicylic acid works to break down scales, making them easier to remove. Prescription corticosteroid shampoo, called Clobex, may be ordered to help lower inflammation from scalp psoriasis.

Severe cases of scalp psoriasis may 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 is found in areas of the body that produce sebum (oil) via oil 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.

Symptoms of seborrheic dermatitis may include:

  • 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

Treatment

Although there is no cure for seborrheic dermatitis, treatment modalities can help alleviate symptoms such as inflammation and itching. Treatment may include:

  • Over-the-counter medicated shampoo
  • Antifungal medications
  • A calcineurin inhibitor (this acts on the immune system to reduce skin inflammation)
  • Corticosteroids (to reduce inflammation)

Ringworm (Tinea Capitis)

Tinea capitis—ringworm—is a type of fungal infection that commonly affects small children.

It often breaks out in schools or daycare centers due to close physical contact between children.

When ringworm is on the head, it’s called tinea capitis; when it occurs on the skin, the name is tinea corporis.

The fungi that cause tinea capitis are very small (microscopic) plant-like organisms; they thrive in damp, warm, dark environments.

When fungus grows on the scalp, ringworm may manifest a small sore that appears pimple-like. Next, the affected area becomes flaky, patchy, or even scaly. The flakes have the same appearance as dandruff, but, unlike dandruff, ringworm may cause the hair to break off, forming a stubble and leaving a bald spot on the head.

Ringworm makes the scalp appear red, and the affected area can be swollen and tender. Sometimes, ringworm causes a mass filled with pus. Scalp ringworm can involve swollen lymph nodes at the back of the neck.

Treatment

Antifungal sprays, cream, or powders may be effective to treat minor tinea capitis. When the condition is more severe, a prescription may be ordered to put on the skin or it may be given orally (by mouth) to treat the fungus systemically (circulating throughout the entire body).

Ringworm on the scalp may require treatment for up to three months. Antifungal shampoo may be recommended by the healthcare provider to prevent the spread of ringworm to others.

Ringworm Spreads Easily

Ringworm is highly 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.

Folliculitis

Folliculitis is an inflammatory disease of the skin and scalp. It affects parts of the body that have hair (and hair follicles), including the head, beard, arms, back, legs, and buttocks.

Anatomically, hair follicles are openings with very small pouches in which hair grows and sebum (oil) is produced. Folliculitis could be caused by a bacterial, fungal, or parasitic infection.

The symptoms of folliculitis, in the affected area, 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 (by mouth) antibiotics or antifungal medication may be prescribed by a healthcare provider.

Acne

Acne is a common skin condition that often affects adolescents but it can occur at any age.

It is linked with excess sebum production, clogged hair follicles, and hormones. Acne is thought to have a genetic link. Acne on the scalp may be influenced 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 are primarily red spots (pimples) that can occur 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 can manifest 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 over-the-counter.

Head Lice

Head lice is a condition caused by live insects that are approximately the size of a sesame seed. They 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.

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)

Treatment

Treatment of lice involves a very specific protocol of killing the lice and getting rid of nits, including:

  • 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.

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.

Symptoms of lichen planopilaris may include:

  • 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 appear like red spots
  • Scales surrounding 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 may be present (but these symptoms are often absent)

Treatment

Treatment 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 aim is to slow down the rate. Oral medications that have anti-inflammatory properties are given for lichen planopilaris, and these may include:

When to See a Healthcare Provider

If you have a condition with red spots on the scalp and over-the-counter medications do not work, it’s time to consult with a healthcare provider.

Anytime you have symptoms of infection (possibly from scratching itchy red spots), it’s also time to see a healthcare provider.

Signs of skin infection include:

  • Redness
  • Fluid or pus draining from the affected area
  • Sores that appear to be blisters
  • Red spots with yellowish crust on top
  • Pain or swelling that worsens (even after home treatment)
  • A fever
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Article Sources
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  1. Michigan Medicine. Scalp problems. Updated February 26, 2020.

  2. Clark, G. American Family Physicians. The treatment and diagnosis of seborrheic dermatitis.  Updated February 1, 2015.

  3. Cleveland Clinic. Seborrheic dermatitis. Updated May 29, 2020.

  4. KidsHealth from Nemours. Ringworm.

  5. American Academy of Dermatology Association. Ringworm: diagnosis and treatment.

  6. Cleveland Clinic. Acne. Updated September 1, 2020.

  7. Dyall-Smith, D. DermNet NZ. Lichen planopilaris. Updated 2011.