Scalp rosacea is an uncommon skin condition causing discoloration or redness and pus-filled bumps on the top of the head. It tends to affect males in an atypical pattern.

Rosacea is a chronic skin condition. It typically affects the face, causing redness or darkening of the skin and visible blood vessels. Sometimes, the granulomatous variant of rosacea can lead to acne-like lesions on the chest, shoulder, arms, and legs.

Rarely, individuals may experience signs of rosacea on the neck, ears, and scalp. This is known as extra-facial rosacea.

Facial rosacea occurs most commonly in adults between 30 and 50 years of age and tends to affect females more than males. Additionally, doctors diagnose it frequently in people with light skin tones.

In contrast, scalp rosacea is more common in older males with hair loss. Scalp rosacea appears as pustules on red or darker brown irritated skin.

This article covers scalp rosacea, its potential complications, and how doctors diagnose it.

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Rosacea is a chronic inflammatory skin condition that usually affects the central face. However, people can also develop rosacea on the scalp.

Those with fair sun-sensitive skin have the greatest risk for rosacea. Experts estimate the prevalence of this skin condition in this population as 2 to 22%.

In contrast, scalp rosacea is an uncommon diagnosis, and few cases feature in scientific literature. When rosacea affects the scalp, it is usually the granulomatous variant.

Firm, yellow, brown, or red papules or nodules on the skin characterize granulomatous rosacea. These lesions can be severe and cause scarring.

Scalp rosacea symptoms

Scalp rosacea presents with a distinct set of symptoms that may include:

  • Erythema: This refers to redness of the scalp, which can be mild to severe. It may appear purple or brown depending on skin tone.
  • Pustules: This involves the development of pus-filled bumps on the scalp.
  • Burning and itching: Individuals with scalp rosacea may experience burning sensations and persistent itching in the affected area.

Risk factors

While the exact cause of scalp rosacea remains unclear, several risk factors can contribute to the development of the condition. These may include:

  • Genetics: A family history of rosacea can increase a person’s susceptibility to developing scalp rosacea.
  • Facial rosacea: Sometimes, a person with scalp rosacea may present with mild facial lesions.
  • Environmental triggers: Exposure to sunlight, temperature extremes, and wind can exacerbate scalp rosacea.

Reports of scalp rosacea complications are uncommon. However, without management — or in severe cases — it could potentially lead to hair loss or alopecia.

Prolonged inflammation and irritation of the hair follicles that scalp rosacea causes may damage the follicles over time. Consequently, individuals with scalp rosacea may experience localized or diffuse hair shedding and thinning, leading to bald patches on the affected areas of the scalp.

Scalp rosacea diagnosis involves a thorough examination of the affected skin by a primary care physician or dermatologist. There is no specific test for rosacea.

Doctors may check a person’s medical history and ask about potential triggers.

After starting treatment or ruling out certain conditions, follow-up appointments to assess how someone responds to treatment and if symptoms have changed or improved may be necessary.

What other condition could it be?

Several other conditions may appear with symptoms resembling rosacea. They include:

  • acne
  • flushing
  • seborrheic dermatitis, an inflammatory skin condition
  • keratosis pilaris rubra, a subtype of keratosis pilaris
  • acute cutaneous lupus erythematosus, an autoimmune condition that causes skin rashes
  • drug-induced acneiform eruption, which occurs when medications induce acne-like lesions

Managing scalp rosacea typically involves a combination of the following:

  • topical treatments
  • oral medications
  • lifestyle modifications

Learn more about treating rosacea.

Medications aim to reduce inflammation, although topical steroids may cause rebound flaring of symptoms.

Though research is limited, case reports and some scientific literature note improvement in symptoms with oral tetracyclines and topical metronidazole. These medications decrease discoloration and reduce hair shedding.

People should also take note of any triggers, such as UV light or alcohol, and take steps to avoid them. Some skin care tips for rosacea are to use:

Consultation with a dermatologist is essential to develop an effective management plan specific to an individual’s needs.

Scalp rosacea is less common than facial rosacea. Rather than affecting younger females as rosacea does, it tends to affect older males with hair loss. It may present as pustules on red or darkened and irritated skin.

Symptoms might include red or purple pustules on the scalp, which can be uncomfortable and itchy.

Treatment aims to reduce inflammation, and people can learn to avoid their specific triggers. Effective management can significantly improve symptoms of this relatively uncommon condition.