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

Red spots on the scalp can be caused by scalp conditions such as scalp psoriasis, seborrheic dermatitis, ringworm, and folliculitis. Depending on the cause, treatments can include OTC medicated shampoos, corticosteroids, and antifungal medications. 

Scalp Psoriasis

Scalp psoriasis is a chronic (long-term) inflammatory condition. Half of those with psoriasis have it on their scalp, where it can look like red spots or sores.

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).

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). The condition 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. 

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.

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, 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.

The fungi that cause tinea capitis are tiny 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 for ringworm 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, which may either be applied to the skin or taken orally (by mouth). Oral medications treat the fungus systemically (circulating throughout the entire body).

Ringworm on the scalp may need treatment for up to three months. Your healthcare provider might recommend antifungal shampoo to prevent the spread of ringworm to others.

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.

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.

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. 

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.

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

The treatment for 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.

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:

• 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)

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:

Acne

Although acne is typically associated with the face, back, neck, and shoulders, it is also possible to get acne on your scalp. You may get whiteheads on your scalp or pink or red bumps called papules that feel tender. You can also develop larger acne nodules and cysts that are deeper in the skin and can be very painful.

Acne on the scalp is often caused by an increase in sebum, the oil that your skin produces, and a buildup of dead cells in the hair follicle. This can block pores and lead to inflammation and pimples on the scalp. Shampoo and other hair products can contribute to scalp acne.

Treatment

Often, the best treatment for scalp acne is a change in the haircare products you’re using. Look for shampoo, conditioner, and other products that don’t contain oil or are labeled as “won’t clog pores,” “non-comedogenic,” or “anti-acnegenic.”

If you have oily hair or use a lot of hair care products, you should wash your hair more often. Make sure to wash your hair whenever you have been in an environment that may cause you to get dirt in your hair or if you have been sweating.

If you wear hats or other clothing items that cover your head, be sure to keep them clean. Wash your bedding often, especially your pillowcases.

If your scalp acne doesn’t improve, try a medicated, oil-free shampoo such as:

• Tar, sulfide, or zinc pyrithione dandruff shampoo
• Salicylic acid shampoo
• Sulfur shampoo
• Antifungal shampoo containing ciclopirox or ketoconazole

In severe cases, your healthcare provider may recommend:

• Antibiotics
• Steroid injections
• Drainage of cysts

Allergic Dermatitis

Allergic dermatitis is a condition that occurs when you are allergic to something that touches your scalp. This can happen if you don’t thoroughly rinse a product out of your hair or if you are sensitive to a product that is designed to be left in the hair. Allergic dermatitis can cause an itchy, red rash.

Shampoo, conditioner, and styling products can all potentially cause this kind of reaction. Many people are also allergic to paraphenylenediamine (PPD), a chemical found in hair dye.

Treatment

Treatment for allergic dermatitis on the scalp is usually as simple as stopping the use of the product that is causing the problem. You may need to begin by stopping the use of all your current haircare products and adding them back to your routine gradually to see which one you are allergic to.

If your scalp is sensitive, look for hair care products labeled as hypoallergenic or for sensitive skin.

Skin Cancer

The scalp is a common site for skin cancer. Although most cancers that appear on the scalp are benign, they account for around 13% of all malignant skin cancers.

Skin cancer on the scalp may appear as red or flesh-colored waxy bumps or as sores or scabs that don’t heal. Because they can be hidden by the hair, they may go undiagnosed for longer than other types of skin cancer.

You should check your skin regularly for suspicious lesions so you can have them examined and treated by a healthcare provider when they are still small. Be sure to check your scalp along with other parts of your body that are regularly exposed to sunlight.

Treatment

The most common types of skin cancer are easy to treat, especially in the early stages. Treatment may include:

• Cryogenic removal (freezing)
• Surgery
• Chemotherapy
• Radiation therapy

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, head lice, and others. 

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.