What causes a bald spot?

The correct explanation depends on the patch’s border, scalp texture, speed of change, symptoms, and whether follicle openings remain visible. One cause cannot be identified safely from the word ‘spot’ alone.

Alopecia areata commonly presents with smooth, sharply defined patches. Fungal infection may produce scale, itch, inflammation, and hairs broken near the scalp. Pulling from tight hairstyles tends to affect areas under repeated tension, while compulsive twisting or plucking can leave hairs of uneven length. Burns, injury, and some inflammatory scalp disorders can replace follicles with scar tissue. Gradual patterned thinning can make one area look bare even though fine miniaturised hairs remain.

Photograph the patch and nearby scalp under steady lighting, then note shedding, breakage, itch, pain, scale, grooming practices, recent illness, and new medicines. Protect the area from tension, scratching, bleaching, and hot tools. Avoid sharing brushes or headwear when a scaly infection is possible. Treatment is cause-specific: a medicine suitable for inflammation may be unsuitable for infection, and hair restoration procedures are considered only after diagnosis and stability are addressed.

Arrange care for a new patch that enlarges, recurs, becomes painful or very itchy, or appears with nail changes or hair loss on other body areas. Prompt dermatology review is appropriate when skin looks smooth and shiny, the follicle openings disappear, or redness and scale persist. Fever, drainage, spreading redness, or fast-growing painful swelling requires urgent evaluation. Scaly patchy loss in a child also needs timely assessment for scalp ringworm.

Ask whether the process is scarring or non-scarring, whether hairs are breaking or shedding, and which examination finding supports the proposed cause. Clarify whether fungal sampling, blood tests based on your history, or a scalp biopsy would change management. Discuss how progress will be photographed and which symptoms should trigger an earlier follow-up.