What are the common reasons for scalp redness and pain? (photos)

Question

This is a follow-up question. I have read about scarring alopecias being a reason for red scalp with pain and hairloss? Are there other possible reasons? I had a period of hair loss in June but hair loss has normalized but scalp is red and tender. I will be having a biopsy and am very worried about the prognoses.

Jae Pak, MD · Answer

You need to see a doctor for your scalp pain and redness.  It is a sign of inflammation.  You can guess on the Internet but it will not be your diagnosis.

Matthew Elias, DO, FAAD · Answer

Thank you for your question.  The redness in your scalp is likely due to either Seborrhea or Psoriasis.  Please follow up with your Board Certified Dermatologist for evaluation and management.  Regards, Dr. Matt Elias

Jeff Donovan, MD, PhD · Answer

Scalp redness has many causes. Without knowing everything about your history from A to Z and seeing all your blood tests and examining your scalp up close, I'd just be guessing. Here, I briefly review the top 12 causes of scalp redness.1) Seborrheic dermatitis.

Seborrheic dermatitis (SD) is an
inflammatory condition of the scalp that affects about 3-5 % of adults. Males
are more commonly affected than females. SD occurs on body sites
where the skin is oily such as the scalp, eyebrows, sides of nose, eyelids and
chest. Individuals with SD of the scalp develop red, flaky skin that is often itchy. The scales can be yellow, white or grey colored and are often
described as being "greasy." This differs from scalp psoriasis where
the scales are often silver and powdery (see below).

2) Psoriasis

Psoriasis is complex immune-based
disease which can affect not only the skin, but also the nails and joints.
Scalp  psoriasis occurs in about 50 % of patients with skin psoriasis. Patients have scalp redness, flaking and scaling. Patients may also have bothersome itching. Although the redness and
flaking often cause embarrassment, scalp psoriasis does not usually cause hair
loss.

3) Scarring alopecias

Scarring hair loss condition or
"cicatricial alopecias” are a group of hair loss conditions which lead to
permanent hair loss. These conditions may frequently be associated with redness of the
scalp as well as scalp itching, burning and/or pain. These include conditions with names such as lichen planopilaris, folliculitis
decalvans, lupus and several others.

4) Other inflammatory diseases

A wide variety of other inflammatory scalp
conditions, including dermatomyositis and rosacea can be associated with
scalp redness. A scalp biopsy can help differentiate these entities.

5) "Red Scalp Syndrome"

'Red scalp syndrome" is a
condition which occurs in individuals who have persistent scalp redness that is
not explainable by any other condition. The condition was first described  by Drs Thestrup and Hjorth Patients with the Red Scalp Syndrome may have itching
and burning but typically do not have scaling or flaking.

6) Irritation

Many products that are applied to the scalp or hair can cause
irritation. These include many cosmetic products, including gel, mousse, hair
spray and hair dyes. Some  treatments for
hair loss can also be associated with irritation and redness, including
minoxidil and other topical products containing irritants such propylene
glycol.

7) Allergy

Shampoos, hair dyes and even some cosmetic products can cause
allergic reactions in the scalp. Although some individuals with allergy have
itching in the scalp, many do not. In such cases, a rash may be present on the
neck, ears or back where the product came into contact with the skin.

8) Infection

Infections are a possible causes of redness. Bacterial, viral
and fungal infections may cause redness in the scalp. Determining the specific
cause may come from a careful history and scalp examination and sometimes
submission of a swab or piece of scalp tissue to the microbiology laboratory.

Bacteria, such as staphylococci, may cause infections of the
scalp. Bacteria may also cause infection of the hair follicle, which is a
condition called " bacterial folliculitis." A variety of viral
infections cause scalp redness. Chicken pox and shingles are two such examples.
Scalp ringworm or “tinea capitis” refers to infection of the scalp by certain
types of fungi. Scalp redness and scaling may be seen in these cases.

9) Alopecia areata

Alopecia areata is an autoimmune condition affecting about 2 %
of the population. IT is not typically a cause of scalp redness. The scalp in
patients with alopecia areata is usually normal in color but may be pink or
peach colored in some cases.

10) Scalp Injury and Trauma

Patients with scalp injuries, either due to previous accidents
or surgeries, may have persistent scalp redness. Burns from fire, chemicals or
radiation can cause redness in the scalp. Burns from ultraviolet radiation,
such as might occur on a sunny day, can cause scalp redness. Patients receiving
radiation for head and neck cancers and brain tumors can also develop scalp
redness.

9) Sun damage

Patients with extensive sun damage, from years of sun expose,
may frequently have a red scalp.

10) Cancers

A variety of pre cancers and cancers of the skin, including non
melanoma skin cancers, can cause redness in localized areas of the scalp. A
biopsy may be obtained to reach the diagnosis.

Conclusion

There
are many causes of scalp redness. Fortunately, the cause of the redness can
often be diagnosed from a thorough examination of the scalp. In complex or
challenging situations, a scalp biopsy should be performed to confirm the
diagnosis.

William Rassman, MD (retired) · Answer

You need to see a dermatologist., Diagnosing your scalp redness is very difficult over the internet. There are many, many causes of this.

What are the common reasons for scalp redness and pain? (photos)

Answers (4)

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