How do we treat sudden onset of acne of the scalp in teens?
Q: My teenage daughter’s hair has become oily over the past couple of months, and it’s causing a lot of small pimples in her hairline and on her forehead. What could cause this change in her hair?
A: During the teenage years, it’s common to have more oil on the skin, including the scalp. As a result of hormone changes that happen during puberty, children who never had oily skin or hair before can begin to develop it as teens. Over-thecounter remedies can usually control breakouts on the scalp. If the problem persists, see your daughter’s primary care provider.
The areas of the body typically affected by acne are those that have the most oil glands — also called “sebaceous glands.” They include the face, forehead, chest, upper back and shoulders. The hair follicles are susceptible to acne because they are connected to oil glands.
During puberty, hormones called “androgens” increase throughout the body, causing the sebaceous glands to enlarge and make more oil, or sebum. But excess oil alone doesn’t cause acne. It’s typically a combination of the oil and dead skin cells, along with bacteria called Propionibacterium acnes, or P. acnes. Those bacteria grow on the skin all the time. When oil production increases during puberty, however, the Propionibacterium acnes have a more readily available food source.
Whiteheads, blackheads and pimples develop when oil, dead skin cells and bacteria clog hair follicles. This combination of factors — clogged follicles or pores, sebum production and Propionibacterium acnes — is the reason multiple medications are often needed.
When excess oil and acne affect the hair and scalp, a good first step is to try an over-thecounter anti-dandruff shampoo. These shampoos reduce the amount of oil on the scalp. Different brands have different active ingredients, such as pyrithione zinc, salicylic acid or selenium sulfide. Choosing two anti-dandruff shampoos with different active ingredients, then switching back and forth between them provides the best results for reducing oil on the scalp. Encourage your daughter to shampoo every other day or daily.
An anti-bacterial soap can also help treat pimples on the scalp if there are not many of them or if they are confined to a small area. As the number of pimples on the scalp increases, it can be difficult to use antibacterial soaps since they don’t work well over large areas.
For forehead acne, a wash containing benzoyl peroxide, in combination with a topical retinoid, such as adapalene, can be useful and are available over the counter.
Contrary to popular myth, acne is not caused by eating greasy food or chocolate, although diets with a high glycemic index may raise the risk for developing acne. Dirty skin isn’t the problem, either. Scrubbing skin that’s affected by acne too hard, or cleaning it with harsh chemicals or soaps can worsen the problem.