A bald spot on the back of a woman’s head

Position alone does not identify the cause. The border of the patch, remaining short hairs, scalp surface, symptoms and history of hairstyles help separate hair shedding from breakage and follicle damage.

A smooth, round or oval patch can be a presentation of alopecia areata. Irregular short hairs near the nape may suggest friction or tension from tight ponytails, buns, braids, extensions, wig attachments or headwear. Tender bumps and crusting can point toward follicle inflammation.

Scalp ringworm may present with a scaly patch, itch and hairs broken close to the skin. A shiny surface with loss of visible follicle openings can suggest scarring and warrants timely specialist review. These appearances can overlap, so self-diagnosis from a photograph is unreliable.

Pause styles that pull at the patch and reposition clips, bands and wig fasteners so they do not repeatedly press on the same area. Detangle gently, reduce high heat and chemical processing, and avoid scratching or applying irritating home remedies. Do not share hair tools or head coverings when scale or infection is possible.

Ask someone to take photographs in consistent lighting because the back of the head is difficult to monitor in a mirror. Record soreness, itch, flakes, bumps, hair breakage and changes in patch size. Bring details of recent hairstyles and product use to a dermatology appointment.

Schedule assessment for a new patch, progressive enlargement, several areas of loss, or a patch that does not improve after traction stops. Seek prompt attention for significant pain, swelling, pus, spreading redness, fever, a soft boggy swelling or rapidly developing loss. Earlier review is also sensible when the skin appears shiny or scarred, because follicle damage may become difficult to reverse.

Ask whether hairs are shedding from the root or snapping, whether follicle openings are preserved, and whether the pattern fits tension, infection, alopecia areata or another inflammatory process. Confirm whether testing is appropriate, which styling changes matter most and how the response to treatment will be judged.