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What causes many brown spots on the scalp, and what should be done about it?

Dec 01, 2025 Source: Cainiu Health
Dr. Liu Wenmin
Introduction
In general, the appearance of numerous brown patches on the scalp may be caused by factors such as sun exposure leading to pigment deposition, friction-induced local hyperpigmentation, café-au-lait spots, pigmented lichen planus, or acanthosis nigricans. It is recommended to seek medical attention promptly, identify the underlying cause, and then improve the condition under a doctor's guidance through general management, medication, or other treatments.

Generally, the appearance of multiple brown spots on the scalp may be caused by factors such as sun-induced pigment deposition, localized hyperpigmentation due to friction, café-au-lait spots, pigmented lichen planus, or acanthosis nigricans. It is recommended to seek medical attention promptly, identify the underlying cause, and follow a treatment plan under medical guidance, which may include general care measures or medication. Below is a detailed analysis:

1. Sun exposure leading to pigment deposition: Prolonged exposure of the scalp to sunlight can stimulate melanocytes via ultraviolet radiation, resulting in brown pigmentation. When going outdoors, wear wide-brimmed hats or use scalp-specific sunscreen sprays to avoid direct midday sun exposure. Cleanse the scalp daily with a gentle shampoo to minimize buildup of dirt and debris.

2. Friction irritation: Frequent wearing of tight hats or scratching the scalp can cause mechanical irritation, leading to abnormal local pigment metabolism. Switch to loose, breathable cotton hats, keep nails trimmed to prevent scratching, use gentle motions when washing hair, and maintain water temperature below 38°C to reduce scalp irritation.

3. Café-au-lait spots: Often associated with genetic factors, these appear as well-defined brown patches without significant discomfort. Follow medical advice to apply topical medications such as hydroquinone cream, tretinoin cream, or azelaic acid cream consistently to lighten pigmentation. Avoid using strong whitening products without medical supervision.

4. Pigmented lichen planus: Inflammatory stimulation leads to proliferation of melanocytes in the scalp, causing pigmented patches accompanied by mild itching or flaking. Treatment may include oral medications prescribed by a doctor, such as epi-cinnarizine hydrochloride capsules, acitretin capsules, or total glucosides of paeony capsules, along with topical mometasone furoate cream. Spicy foods should also be avoided.

5. Acanthosis nigricans: Often related to obesity or endocrine disorders, this condition presents as velvety, thickened, brownish patches on the scalp. Management includes weight control and topical application of medications such as tretinoin cream, urea ointment, or salicylic acid ointment as directed. In severe cases, laser therapy or dermabrasion may be performed to remove thickened pigmented tissue.

In daily life, increase intake of vitamin C-rich foods such as strawberries and kiwifruit. Regularly change pillowcases and keep the scalp clean and dry. Avoid frequent perming or hair dyeing to reduce chemical damage to the scalp. Comprehensive scalp care helps promote overall scalp health.

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