A bald spot in the middle of the scalp

Use mirrors or photographs to determine whether the area has a sharp border, diffuse see-through density or short broken hairs. The crown's natural whorl can expose scalp under bright light without being a true bald patch. Comparing images taken with the same hairstyle and lighting is more informative than checking from different angles each day.

Gradual crown thinning often preserves fine hairs across the area rather than creating bare skin overnight. Alopecia areata can present with a smooth, defined patch. Scale, itch and broken hairs can occur with scalp ringworm, while tenderness, bumps or a shiny surface may signal inflammation that threatens follicles. Hairstyles that pull from the centre or repeated pressure can contribute in a pattern matching the tension.

Part the hair through the same line and take overhead photographs in even light. Note shedding, breakage, itch, pain and flaking. Loosen tight styles and avoid chemical relaxers, vigorous brushing or high heat over a tender area. Gentle washing helps reveal the true scalp surface; coating it heavily with oils can hide scale and worsen some irritated conditions. Treatment should follow examination rather than location alone.

Arrange a dermatology assessment if the visible area is enlarging, the scalp is sore or itchy, or the surface becomes smooth and shiny. Pus, marked swelling, fever or a painful soft swelling calls for prompt medical care. Loss spreading beyond the centre or appearing in eyebrows and eyelashes is another reason to book a visit. Early review is especially useful when scarring is suspected because lost follicles may not recover.

Show the clinician older photos if available and ask whether the area represents thinning, breakage or a sharply defined patch. Find out whether scalp magnification or testing for infection would help, and whether your styling practices place tension on the centre. If hair restoration is discussed, ask first whether the hair-loss process is stable and whether enough healthy follicles remain for that option.