Scalp Lesions

Overview

Scalp lesions are any abnormal areas on the scalp, including bumps, lumps, sores, scaly patches, blisters, or growths. Because the scalp is often hidden by hair, lesions may go unnoticed until they are felt while washing or styling the hair. They range widely in cause, from very common and harmless cysts and inflamed hair follicles to skin conditions, infections, and, occasionally, skin cancer.

Most scalp lesions are benign and either resolve on their own or respond to simple treatment. The key is to recognize the smaller number of lesions that warrant evaluation, particularly those that grow, bleed, fail to heal, or change over time. Sun-exposed scalp skin, especially in people with thinning hair, is a common site for skin cancers.

Common Causes

Scalp lesions can arise from glands, follicles, skin conditions, infections, or growths:

• Cysts: Smooth, movable lumps under the skin, such as epidermoid or pilar cysts, are very common on the scalp.
• Folliculitis: Inflamed or infected hair follicles forming tender, pus-filled bumps.
• Seborrheic dermatitis and psoriasis: Scaly, red, sometimes crusted patches.
• Seborrheic keratoses and moles: Benign growths that can appear on the scalp.
• Warts: Rough, raised growths caused by a virus.
• Infections: Bacterial or fungal infections, including ringworm of the scalp.
• Skin cancer: Basal cell, squamous cell, or, less often, melanoma, particularly on sun-exposed scalp.

Associated Symptoms

Accompanying features help indicate the cause and urgency:

• Pain, tenderness, or pus (infection or folliculitis)
• Itching, scaling, or crusting (skin conditions)
• A smooth, painless lump that has been stable for years (likely a cyst)
• Hair loss in or around a lesion (fungal infection or some cancers)
• Bleeding, oozing, or a sore that will not heal
• A growth that changes in size, shape, or color

A lesion that bleeds, fails to heal, grows, or changes appearance should be evaluated to rule out skin cancer.

Diagnosis & Evaluation

Evaluation aims to identify the lesion and exclude anything serious:

• Examination: Inspecting and feeling the lesion for size, texture, tenderness, and features.
• Dermoscopy: A magnified, lighted view to assess suspicious growths.
• Skin scraping or culture: Testing for fungal or bacterial infection.
• Biopsy: Removing a small sample for examination if a lesion could be cancerous or the diagnosis is unclear.

Treatment & Management

Treatment depends entirely on the type of lesion:

• Cysts: Often left alone if not bothersome; a clinician can remove or drain those that are painful, infected, or growing.
• Folliculitis and infections: Good hygiene, warm compresses, and antibiotic or antifungal treatment as needed.
• Skin conditions: Medicated shampoos and topical treatments for seborrheic dermatitis or psoriasis.
• Warts and benign growths: Removal by freezing, topical treatment, or minor procedures if desired.
• Skin cancer: Surgical removal and other treatment guided by the type and stage.
• Monitoring: Watching stable, harmless lesions over time and reporting any change in size, shape, color, or symptoms.

Any lesion suspicious for cancer is best evaluated and treated promptly, since early skin cancers are usually highly treatable. Because the scalp is hidden by hair and is easy to overlook, it helps to check it periodically using a mirror or with the help of a partner, hairdresser, or family member. Bringing any new, growing, bleeding, or non-healing lesion to a doctor's attention without delay gives the best chance of a simple, successful treatment.

Self-Care & Prevention

• Protect a thinning or bald scalp from the sun with a hat or sunscreen
• Keep the scalp clean to reduce folliculitis and infection
• Avoid picking, squeezing, or scratching lesions
• Check the scalp periodically, including with a mirror or help from someone else
• Avoid sharing combs, hats, or towels if a fungal infection is suspected

When to See a Doctor

See a doctor or dermatologist for any scalp lesion that concerns you, and promptly for one that:

• Bleeds, oozes, crusts, or will not heal
• Grows or changes in size, shape, or color
• Is painful, rapidly enlarging, or accompanied by hair loss
• Shows signs of infection such as spreading redness, warmth, or pus
• Has irregular borders or several colors

These features can indicate a skin cancer or a significant infection that benefits from early diagnosis and treatment.

Related Topics

Frequently Asked Questions

References

1. American Academy of Dermatology Association. Skin cancer and scalp lesions.
2. Mayo Clinic. Skin cancer — Symptoms and causes.
3. MedlinePlus, U.S. National Library of Medicine. Skin lesions.
4. Centers for Disease Control and Prevention (CDC). Skin cancer prevention.