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Scabs on Scalp: Everything You Need to Know

Scabs on your scalp can be painful, unsightly, and stressful. They are caused by a multitude of different reasons and conditions – many of which look similar and are easily confused. If this uncertainty wasn’t enough to worry about, many people are also concerned that their scalp scabs will cause permanent hair loss.

The answers all come down to the cause of the scabs, and in this article, we’ll explore the different conditions which cause scalp scabs, what the conditions look like, what you can do to treat them, and what they’re doing to your hair.

Table of Contents

What are scalp scabs?

When the skin is broken, blood (or other liquid in the case of infection) is released and hardens into a protective scab over the open area. Beneath the scab, the skin regenerates and eventually the scab will shed naturally.

However, depending on the severity of the skin damage, scabs can sometimes take weeks to heal and can be unsightly or inconvenient. Scabs also usually itch as they heal, which can cause people to scratch and open the original sore again, resetting the healing process and opening up the body to infection.

Scalp scabs are simply scabs that form on the head around the hair. Due to their location, people are often concerned that the hair follicles beneath could be impacted and may lead to hair loss. If you have developed scabs following a hair transplant this is a normal part of recovery.

Can scalp scabs cause permanent hair loss?

Unfortunately, some of the conditions which cause scabbing on the scalp can lead to permanent hair loss due to the development of scar tissue. In these cases, topical treatments like Minoxidil and Finasteride will be ineffective and measures such as hair transplantation are the next step to consider. Read more about hair transplants into scar tissue.

However, many conditions which cause scabs on the scalp to develop will not affect hair at all or affect hair only temporarily. Read through the conditions below for more information.

What’s causing scabs on my scalp?

Lice and scabs on the scalp

Head lice and nits are tiny insects that live on the scalp and are highly contagious. As they feed on blood, lice bite the scalp which causes an itching sensation. Lice are transferred through head-to-head contact and contrary to popular belief, are not linked to poor hygiene. The main symptom of lice is an itchy scalp. When scratched too hard, this can cause scabs on the scalp.
Bleeding sores and scabs as a result of scratching due to the presence of lice
Bleeding scalp sores and scabbing on the scalp as a result of scratching due to the presence of lice
Lice can be diagnosed at home by finding live insects in the hair. This can be made easier by checking with a fine-toothed comb. The most common spots for a lice infestation are at the top of the neck and behind the ears, but it can affect anywhere on the scalp and can affect anyone.

Did you know? An estimated 6 – 12 million lice infestations occur every year in the United States alone [1].

Treating lice and scabs on your scalp

In most cases, you can treat lice at home. The NHS recommends initially treating the infection with wet combing and if this method is unsuccessful after two weeks, a pharmacist can advise different medicated shampoos. Everyone in the household should be checked for lice due to their contagious nature.

All bedding, clothing and fabric that may have come into contact with the infested scalp must be washed in hot water and dried on a hot cycle (temperatures over 53.5°C / 128.3°F kill lice and eggs after 5 minutes). Anything that cannot be washed can be sealed in plastic bags for at least 2 weeks, giving enough time for all the nits to hatch and die.

Medicated lotions and shampoos are easily available from supermarkets, pharmacies, and online stores. Key ingredients to look for in a medicated shampoo are pyrethrin and dimethicone. Products containing permethrin or plant-based herbal remedies should be avoided. Permethrin only kills live lice, leaving unhatched eggs in the hair, while herbal remedies are far less effective than medicated treatment, usually only killing a small number of lice.

Removing the lice will end the itching sensation and allow scabs to heal without infection. Lice ‘repellents’ and other preventative products should also be avoided as they can irritate the scalp and in turn, lead to scabbing.

Lice and curative treatments won’t cause hair loss directly, but the secondary effects of itching and scalp irritation can lead to breakage and damage. This is likely to be minimal and your hair will quickly recover.

Contact dermatitis and scalp scabs

Contact dermatitis is a form of eczema caused by contact with irritating or allergenic substances. It presents as an itchy, dry rash which may appear red or dark brown depending on skin colour and can occur anywhere on the body. Contact dermatitis itself does not cause scabs but itching the rash can cause bleeding, open sores, and subsequently scabbing.

Red contact dermatitis rash
Red contact dermatitis rash

Treating contact dermatitis

Contact dermatitis on the scalp is usually caused by ingredients in hair products or soaps, including shampoos, conditioners, hair dyes, styling products, and other topical treatments. As long as the trigger is removed, contact dermatitis often will resolve on its own.

In cases of more severe reactions, antihistamines or corticosteroids may be prescribed by the doctor. Sores and scabs can also become infected if scratched and opened again and can create recurring scabs in the same spot. So you should speak to a doctor if concerned as you may need antibiotics.

Psoriasis and scalp on the scabs

Psoriasis is a chronic autoimmune condition which can affect skin all over the body, including the scalp. With this condition, skin cells are overproduced too quickly. Rather than being replaced every 3 – 4 weeks, skin cells are replaced every 3 – 7 days. This results in a build-up of cells which present as flaky, scaly patches of skin [2].

The full cause of psoriasis isn’t understood but it often runs in families and can be triggered by injury, infection, or medication. It is not contagious.

Patches of scaly skin often appear on the scalp, lower back, knees, and elbows but can affect anywhere on the body. Usually small, itchy, and sore, the patches will disappear and flare up over time. For some people, however, psoriasis can be a serious condition impacting their day-to-day life.

On the scalp, psoriasis can often be confused for dandruff as both cause flaky and itchy skin. The best way to differentiate is to look closely at any redness or rash. Psoriasis patches have clearly defined edges while dandruff redness is caused by scratching at the scalp. If you’re unsure, a doctor will be able to diagnose by inspecting the scalp.

Psoriasis affecting scalp at the top of the neck (left), psoriasis affecting scalp behind the ears (right)
Psoriasis affecting scalp at the top of the neck (left), psoriasis affecting scalp behind the ears (right)

Did you know? Psoriasis affects around 2 in 100 people in the UK. It can affect anyone and start at any age.

Treating psoriasis

Because it causes itchy sores, psoriasis can cause scalp scabs when patients scratch the inflamed skin and cause bleeding. Hair loss can sometimes occur as a result of this scratching and is only temporary. There are also a number of treatments that help alleviate symptoms and improve the appearance of patches. There is no cure for psoriasis.

Topical emollients, corticosteroids, or vitamin D analogues (a synthetic vitamin D cream) are usually the primary treatment. Doctors may prescribe phototherapy in more severe cases which involves directing ultraviolet light at the skin. For patients who prefer natural remedies, black seed oil has been shown to be an effective treatment for psoriasis in animal studies [3]. Apple cider vinegar is also widely believed to reduce psoriasis-related itching.

Specifically for psoriasis of the scalp, medicated shampoos can help to reduce itching and therefore scabbing. Key ingredients to look for are coal tar and salicylic acid. Patients sometimes also find certain lifestyle triggers can worsen their psoriasis, such as smoking or stress.

Impetigo and scalp scabs

Impetigo is a highly contagious skin infection that usually affects the face but can be easily spread through scratching. It is caused by a bacterial infection when the skin is broken, either by injury or damage. Usually, the bacteria is either Staphylococcus aureus or Streptococcus pyogenes, and the resulting impetigo manifests as either impetigo or non-bullous impetigo.

Bullous impetigo is marked by the appearance of blisters, usually across the torso or on the arms and legs. They quickly spread and burst, leaving a yellow crust. The skin surrounding the blisters is often sore and itchy and while the blisters do not scar, scratching at the sores can cause marks and spread infection.

Bullous impetigo blisters
Bullous impetigo blisters on a child's stomach
Non-bullous impetigo more commonly affects the face, especially around the mouth and nose, and is more likely to lead to scabbing on the scalp as a result. Rather than fluid-filled blisters, this form of impetigo presents with red sores that burst and leave substantial, golden crusts. These patches are usually not painful but can be itchy. Scratching can worsen the sores, spread impetigo, and bring infection.
Non-bullous impetigo scabs surrounding mouth
Non-bullous impetigo scabs surrounding a child's mouth

Both types of impetigo are highly contagious and can be spread through close physical contact or contact with contaminated fabric like clothing or sheets. Symptoms do not present until 4 – 10 days after exposure.

A third form of impetigo affects hair follicles specifically. Often called Bockhart impetigo, it presents as folliculitis and is caused by the Staphylococcus aureus bacteria. In severe cases, this form of impetigo leads to sycosis barbae, where the affected area is covered in tinder, itchy pus-filled lesions, spots, and abscesses around the hair follicle. It most commonly occurs in areas where hair is shaven, including the beard area, groin, and scalp [4].

Severe sycosis barbae
Patient suffering severe sycosis barbae caused by Bockhart impetigo across his beard

Treating impetigo

While impetigo does not need treatment to be cured (it will improve naturally over 2 – 3 weeks), due to its contagious nature, treatment is usually preferred. Doctors will prescribe antibiotics, either oral or a topical treatment, for a week. To avoid scabs from forming on the scalp, patients should resist scratching the patches and let them heal quickly.

Neither bullous nor non-bullous impetigo cause lasting scars and so should have no permanent effect on a patient’s hair.

If Bockhart impetigo/impetigo of the hair follicle leads to sycosis barbae, patients are often left with areas of scarring that result in permanent hair loss. Once scarring has occurred, topical treatments such as Finasteride or Minoxidil will not help hair regrowth and the only completely restorative step would be a hair transplant.

Injuries and scabs on the scalp

Minor injuries to the head can cause scabs to form on the scalp if the skin is broken. While healing, these scabs may itch, and you may find your scalp hurts when you move your hair. Scratching should be avoided to limit the chances of infection and stop the injuries from reopening, delaying healing.

Treating injuries

If minor, scalp injuries will heal on their own. You should keep the wound clean and dry until healed over. If caused by a more serious head injury, medical attention should be sought to make sure there are no deeper injuries.

Some serious scalp lacerations and injuries may result in scar tissue, which can lead to permanent hair loss. In this case, topical treatments such as Minoxidil or Finasteride will not help so options such as a hair transplant should be considered.

Folliculitis and scabs on the scalp

Folliculitis occurs when hair follicles become infected and develop into pimples or sores. Folliculitis can occur after a hair transplant or shaving and only presents around the irritated hair follicle rather than affect patches of the scalp. 

Folliculitis on a closely-shaven scalp
Widespread outbreaks of folliculitis on a closely-shaven head
If these pimples or sores are scratched, they can develop into scabs and can cause temporary hair loss but will quickly grow back.

Treating folliculitis

Steps to avoid folliculitis include:

  • Exfoliating the skin before shaving
  • Using a new razor each time, or keeping the razor dry between uses
  • Applying a topical after-shave treatment such as Sudocrem

Eosinophilic folliculitis and scabs on the scalp

Eosinophilic folliculitis is mostly found in people suffering from late-stage HIV/AIDs or in individuals who have experienced a bone marrow transplant, and so is not contagious in itself. It causes the development of itchy, red, pus-filled sores and bumps which eventually scab over and leave a dark mark on the skin. These sores can occur anywhere on the body.

Eosinophilis foliculitis on the neck
Eosinophilis foliculitis on the neck

Treating eosinophilic folliculitis

Treatment is dependent on the cause of the folliculitis. For those with HIV/AIDS, it is likely to improve and resolve with treatment such as HAART (Highly Active Anti-Retroviral Therapy) [5]. For others, medical professionals may prescribe a range of remedies including antibiotics, phototherapy, steroids, or antihistamines.

Pilar cysts and scabs on the scalp

Pilar cysts are cysts which develop around hair follicles and so are commonly found on the scalp, affecting middle-aged women predominantly. They are not contagious but are believed to run in families. The cyst itself is a small fluid-filled sac under the skin, usually keratin, which will be expressed as a yellow, thick paste if burst. In this case, the cyst may also bleed and scab over.

Pilar cyst on the scalp
Pilar cyst on the scalp
Pilar cysts can easily be confused with other types of lumps and bumps, so if you’re concerned, make an appointment with your GP.

Treating pilar cysts

Pilar cysts are not dangerous and usually heal on their own. It is strongly advised not to burst them yourself as this risks spreading infection, while the cyst may refill as the sac remains under the skin.

Medical professionals can remove cysts, although often this can only be done privately, and will leave a small scar. Rather than removal, doctors can also help reduce swollen or inflamed cysts with a steroid injection. Smaller cysts can be dealt with at home: the NHS recommends holding a warm compress to a cyst multiple times daily to encourage healing [6].

With large, inflamed cysts, hair follicles can be put under notable pressure and patients may notice light hair loss. If the cyst is infected, hair growth will be further negatively impacted.

However, once the cyst is treated, either through complete surgical removal or a steroid injection, hair is expected to quickly regrow in these areas. Regular steroid injections, however, can also have a negative impact on hair growth and so it is important to discuss your progress with a medical professional.

Shingles and scabs on the scalp

Like chickenpox, shingles is caused by the varicella-zoster virus but unlike chickenpox can affect people of any age. It presents as a painful rash marked by blisters which burst and scab over. The liquid within the blisters is highly contagious and scratching should be avoided as much as possible, while hygiene is key to reducing spreading.

Shingles affect only one side of the patient and are most often present on the face and body. However, it can also appear on the scalp, leaving it highly tender and sensitive. In this case, patients must take care to be very gentle with their scalp blisters as shingles can develop into scarring alopecia, a form of permanent hair loss.

Scarring alopecia, also known as cicatricial alopecia, develops when the hair follicle is damaged or destroyed. With regard to shingles, the virus destroys key stem cells within the follicle leaving hair unable to grow. Scratching and further damage to the blisters increase the chances of this damage.

Patients may also experience general, widespread shedding even when the shingles virus is not present on the scalp. This is a side-effect of the stress on your body which the illness causes and is termed telogen effluvium. It is temporary and usually lasts only 12 months, and treatments such as Minoxidil or Finasteride can help accelerate this timeline after the shingles have passed.

Treating shingles

Shingles attack the nerves and can cause persistent pain after the rash has passed, meaning that quick treatment is important. A doctor will usually prescribe antivirals after a visual examination and diagnosis.

For patients experiencing blisters on their scalp, key steps can be taken to avoid further trauma and associated permanent scarring:

  • Pat hair dry rather than rubbing or using heat tools
  • Use gentle, unscented hair cleansers and avoid all hair care products
  • Wash the hair gently with lukewarm water, avoiding tugging the strands

For scalp relief, a cold compress may help to soothe the itching sensation. Menthol and calamine lotion can also offer relief.

Lichen planopilaris and scabs on the scalp

Lichen planus is a skin condition that causes a raised, itchy, rash that presents in blotchy clusters on the skin. Generally, the rash often affects the arms, legs and torso, the mouth, the nails and scalp, and the genital areas. Lichen planus is a T cell-mediated disease, meaning that it is an autoimmune disease caused by a malfunctioning immune system which mistakenly attacks the skin [7]. It is not contagious nor passed through the family and generally requires a skin biopsy to diagnose.

When lichen planus affects areas with hairs, it is known as lichen planopilaris and can lead to permanent hair loss. The rash destroys hair follicles and causes scarring, meaning that topical hair treatments such as Minoxidil and Finasteride would be ineffective.

Scar tissue left on the scalp from lichen planopilaris
Scar tissue left on the scalp from lichen planopilaris

Treating lichen planopilaris

There is no specific cure for lichen planopilaris, but various treatments can improve the symptoms. To reduce the itching sensation, steroid creams are often prescribed and help to control the rash. Untreated, it usually improves between 9 to 18 months, and once it has passed is unlikely to return.

At-home remedies to relieve lichen planus include:

  • Applying a moisturising emollient to the affected areas
  • Avoid scented soaps

Treating hair loss caused by this condition would involve solutions such as a hair transplant to blend any scar tissue in with the rest of the scalp. Less invasive measures also exist, including wigs and scarves to conceal any balding areas or micropigmentation tattooing, which gives the illusion of hair depth.

Seborrheic dermatitis and scabs on the scalp

Seborrheic dermatitis is a form of eczema where an itchy, red rash develops in oily areas such as the scalp or upper back. It can present in various ways and can be easily mistaken for other afflictions so medical diagnosis may be required. It is not contagious but can develop in people of all ages and ethnicities. It is most commonly known as cradle cap when present on a baby.

The condition is caused by the body’s negative reaction to excess Malassezia yeast which occurs naturally on the skin’s surface. Genetic and environmental features are believed to also influence the condition, although the full cause is not completely understood [8].

In adults, seborrheic dermatitis is often confused for dandruff as both conditions present with whitish flakes on the scalp and an itching sensation. Both are caused by the Malassezia fungus and dandruff can be considered the mildest form of seborrheic dermatitis.

However, dandruff is restricted to the scalp while seborrheic dermatitis can develop in many further spots including eyebrows, around the nostrils, and on the chest. Seborrheic dermatitis is also marked by inflammation.

Hair loss is only a secondary effect of seborrheic dermatitis. The condition itself does not negatively affect hair, but shedding and damage may be experienced as a result of scratching the rash. Learn more about causes of and treatments for seborrheic dermatitis on the NHS.

Treating seborrheic dermatitis

There is no cure for seborrheic dermatitis but symptoms can be very effectively managed and the condition does occasionally resolve on its own, especially in younger sufferers. Many adults find it occurs in seasonal flares with the condition rarely occurring during humid months. Stress, hormonal changes, harsh chemicals, HIV, and Parkinson’s disease are other triggers.

Medical advice is recommended to help those with seborrheic dermatitis develop a personalised health plan. A topical antifungal cream and emollients are usually the first step but in more extreme cases, doctors may prescribe corticosteroids.

Certain skincare steps at home can also help reduce and control the symptoms, such as:

  • Wash affected skin with antifungal cleansers containing ingredients such as 2% zinc pyrithione or selenium sulfide
  • Consider a dandruff shampoo (or other sensitive-skin shampoos)
  • Use hair cleansers containing coal tar or salicylic acid which act as keratolytics and loosen dead cells from the skin

Ringworm and scabs on the scalp

Ringworm is a common fungal infection that derives its name from the ring-shaped rash which usually appears. This distinctive rash may present slightly differently if occurring on or around the face. It can also spread and join other rashes to cover an irregular patch of skin.

Widespread case of ringworm with individual patches as well as an irregular central ringworm rash
Widespread case of ringworm with individual patches as well as an irregular central ringworm rash

The rash may appear anywhere on the body and is usually scaly and itchy. It is highly contagious and spread through physical contact or touching contaminated materials such as clothes, sheets, or towels.

When ringworm occurs on the scalp, hair begins to break off near the scalp leaving scaly, bald patches with dark spots (broken hair shafts). These bald areas will grow if untreated, and in more extreme cases, will swell, release pus, and be marked by a yellow or white crust. This can quickly lead to permanent hair loss as these areas scar and leave the hair follicles unable to grow.

Ringworm on the scalp
Ringworm on the scalp

Treating ringworm

Oral antifungal medications usually work within 6 weeks, although can often have digestive side effects. It is normal not to see any change for the first month.

For ringworm on the scalp, medicated shampoos may be prescribed to stop the ringworm fungus from spreading – not killing it – so these must be used in conjunction with oral treatment.

Like other forms of permanent scarring, treating hair loss caused by this condition would involve solutions such as a hair transplant to blend any scar tissue in with the rest of the scalp. Less invasive measures also exist, including wigs and scarves to conceal any balding areas or micropigmentation tattooing, which gives the illusion of hair depth.

What can I do to stop scratching?

It is important that you avoid scratching your scalp scab. Opening rashes, scabs, and sores can easily lead to infection, cause or worsen hair loss, and lead to scarring. Some general steps that you can take to reduce the sensation of itching include:

  • Apple cider vinegar rinse
  • Coconut oil and other emollients
  • Sensitive skin and dandruff shampoos
  • Peppermint oil
  • Colloidal oatmeal washes
  • Salicylic acid
  • Tea tree oil
  • Aloe vera gel
  • Products including coal tar (be aware, it may affect hair colour)

However, you should only treat your skin condition once you’ve identified it, as some popular itching remedies are not appropriate for all the conditions discussed here. If you’re unsure, or if these OTC and home remedies aren’t working, seek professional medical advice.

How can I help my scabs heal?

The most important thing you can do to help the scabs on your scalp heal is to avoid breaking the skin again, so no scratching or rough brushing. Keep the area clean and dry as much as possible, and maintain treatment for the underlying condition.

Other tips to help speed up the healing process involve:

  • Avoid styling products and tools while scabs heal as heat and unnecessary manipulation could cause the skin to break again.
  • Invest in a gentle or sensitive-skin shampoo and reduce events which could cause sweat, germs, and oils to build up on the scalp.

My scabs have caused hair loss – what can I do?

While some conditions can cause permanent hair loss, there are still plenty of options for you to feel happy with your appearance. Wigs or hair covers can help conceal areas of hair loss, or alternatively, more permanent options such as hair transplant can help restore your previous appearance.

However, the path forward following permanent hair loss depends on individual circumstances. Book a free consultation at the Wimpole Clinic to diagnose your hair loss and find the right treatment path to restore your hair.

Scabs on Scalp: Everything You Need to Know, Wimpole Clinic

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