Why do I get pimples on my scalp?

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Pimples on the scalp are usually folliculitis - inflamed or infected hair follicles - rather than true acne, though the two look alike. The drivers: oil, sweat, and product buildup clogging follicles - hats, headbands, heavy conditioners, dry shampoo, and infrequent washing all contribute; friction from helmets and hats; and occasionally yeast or bacteria taking up residence in the follicle. MedlinePlus describes folliculitis as pus-filled bumps at the hair root, sometimes itchy or tender, and notes most mild cases clear with hygiene measures. A related impostor: acne keloidalis - bumps at the nape and hairline, mostly in men with curly hair who shave close - which scars if managed wrong.

The wash routine that clears most cases: shampoo regularly - daily if oily or sweaty - with a gentle or anti-dandruff shampoo containing zinc pyrithione or ketoconazole, which also tackles the yeast driver; rinse product out thoroughly; wash hats and pillowcases often; skip heavy oils and pomades at the roots; and do not pick or squeeze scalp bumps - scarring folliculitis loses hair permanently.

When to escalate: bumps that are painful, spreading, or forming boils; patches of hair loss with scaling - ringworm of the scalp needs prescription treatment; bumps leaving scars or permanent bald spots - a dermatologist, promptly, since scarring folliculitis destroys follicles; and anything not clearing after two to four weeks of the routine.

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