What a bald spot at the back of the head may mean

A smooth round patch can occur with alopecia areata. Scaling, broken hairs, itch or tenderness may accompany scalp ringworm. Repeated rubbing, tight hairstyles, pulling, burns or other injury can also produce local loss. The appearance and speed of change matter more than location alone.

Alopecia areata often presents with sharply defined, smooth bald patches and little surface change. Scalp ringworm more often presents with scale and hairs broken at different lengths; it is contagious and generally needs prescription medicine taken by mouth rather than shampoo alone. A shiny patch with loss of visible follicle openings can suggest scarring, where early assessment matters because destroyed follicles may not regrow hair.

Pressure or friction can affect the occipital scalp, especially after prolonged immobility or repeated rubbing. Traction tends to follow the areas carrying tension from braids, extensions or tightly secured styles. A clinician may also inspect nails, eyebrows and the rest of the scalp for clues.

Photograph the patch in consistent lighting and note itching, scale, pain, recent illness, new medicines, hair practices and contact with anyone who has a scaly scalp. Stop tight styles and minimise heat, harsh chemicals and friction while arranging an assessment. Do not share combs, hats, pillowcases or clippers if ringworm is possible.

Avoid steroid creams, antifungal creams or hair-growth products until the cause is clearer; scalp infection can require oral treatment, while inflammatory and scarring disorders need different plans. Hair transplant is not a first response to a new unexplained patch and is unsuitable while loss is active or infection is present.

Seek prompt medical care for a painful, boggy or pus-filled scalp swelling; fever; spreading redness; swollen neck glands; or rapid expansion of hair loss. Children with a scaly patch or broken hairs should be assessed promptly because scalp ringworm can spread and needs appropriate prescription treatment. Also arrange a dermatology review for shiny scar-like skin, burning, persistent tenderness or loss involving eyebrows or eyelashes.

Ask whether follicles are still visible, whether hairs are broken or shed from the root, and whether fungal testing or a closer scalp examination is needed. Clarify whether household members need checks, which grooming tools require cleaning and how improvement will be monitored.