Black Spots on the Scalp: Causes and Treatments

Black circular spots on the scalp?

Dear Dr.
Zhou,
I recently discovered a black round spot on the back of my head (where my long hair is), approximately 0.2 to 0.3 centimeters in size.
I would like to ask you the following questions:
1.
Can benign moles develop on the scalp? Based on your clinical experience, is it common for people to have moles on their scalp, and is there a necessity to remove such moles? (Considering the potential for malignancy, etc.)
2.
I have oily skin and often experience redness and pus on my scalp due to folliculitis (similar to acne).
Could the black round spot on the back of my head possibly be post-inflammatory hyperpigmentation (PIH) resulting from the healing of folliculitis?
3.
If the black round spot on the back of my head is indeed post-inflammatory hyperpigmentation (PIH), will it gradually fade on its own, or will it persist and require external intervention for removal?
Thank you, Dr.
Zhou.

Axiang, 30~39 year old female. Ask Date: 2020/01/05

Dr. Zhou Hongzhang reply Plastic Surgery

1.
Benign moles can develop on the scalp.
If the mole does not change, it may not require treatment.
2.
Yes, the black circular spot on the back of the head could be post-inflammatory hyperpigmentation (PIH).
3.
Yes, if it is post-inflammatory hyperpigmentation (PIH), the black circular spot will gradually fade on its own.

Reply Date: 2020/01/05

More Info

Understanding black spots on the scalp can be a source of concern for many individuals. Based on your description of a black circular spot on the back of your head, measuring approximately 0.2 to 0.3 centimeters, there are several potential causes and considerations regarding its nature and treatment.

1. Benign Nevi (Moles) on the Scalp: Yes, it is indeed possible for benign moles, also known as nevi, to develop on the scalp. These moles can vary in color, size, and shape, and they are generally harmless. However, it is essential to monitor any changes in the mole's appearance, such as asymmetry, irregular borders, color variation, or an increase in size, as these could indicate a risk of malignancy. In clinical practice, many dermatologists recommend periodic skin checks, especially for individuals with a history of skin cancer or those with numerous moles. If the mole appears stable and does not exhibit concerning features, it may not require removal. However, if there is any doubt, a consultation with a dermatologist is advisable for a thorough evaluation.

2. Folliculitis and Post-Inflammatory Hyperpigmentation (PIH): Given your oily skin and history of folliculitis, it is plausible that the black spot could be a result of post-inflammatory hyperpigmentation (PIH). PIH occurs when the skin darkens following inflammation or injury, such as from acne or folliculitis. The darkening is due to an excess production of melanin in response to the inflammation. If the black spot is indeed PIH, it may take time to fade. The duration for PIH to resolve can vary widely among individuals, depending on skin type, the severity of the inflammation, and other factors. While some cases may resolve on their own over weeks to months, others may persist longer.

3. Management of PIH: If the black spot is confirmed to be PIH, there are several treatment options available to help expedite the fading process. Topical treatments containing ingredients such as hydroquinone, retinoids, vitamin C, or azelaic acid can be effective in lightening hyperpigmented areas. Additionally, procedures like chemical peels, microdermabrasion, or laser therapy may be considered for more persistent cases. However, it is crucial to approach these treatments under the guidance of a dermatologist to ensure safety and efficacy.

In conclusion, while the black spot on your scalp could be a benign mole or a result of post-inflammatory hyperpigmentation, it is essential to have it evaluated by a healthcare professional. Regular monitoring of any skin changes, maintaining good scalp hygiene, and addressing any underlying conditions such as folliculitis can help manage and prevent further issues. If you have concerns about the appearance or changes in the spot, do not hesitate to seek a dermatologist's opinion for a definitive diagnosis and tailored treatment plan.

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