What causes bald spots on the scalp?

The patch itself provides useful clues: smooth skin, scale, broken hairs, redness, pustules and loss of follicle openings do not all suggest the same process. More than one process can coexist, so appearance should guide an assessment rather than serve as a self-diagnosis.

Alopecia areata frequently presents with one or more smooth, clearly bordered patches. Scalp ringworm commonly presents with scale and fragile or broken hairs and may also cause itch or inflammation. Hair pulling tends to leave hairs at mixed lengths, while constant traction can follow tight braids, extensions or headwear.

Inflammatory scalp disorders may cause burning, tenderness, redness or scaling before obvious loss. When inflammation destroys follicles, the surface can look smooth or shiny and regrowth may be limited. Gradual hereditary thinning usually follows a broader distribution at the hairline or crown instead of an isolated bare island.

Note when the spot appeared, whether it is enlarging and whether hair sheds from the root or breaks near the scalp. Check for itch, pain, scale and drainage, and mention recent hairstyles, chemical treatments, illness, medicines and contact with people or animals that have a scaly rash.

Use gentle hair care and release styles that pull. Avoid picking, vigorous brushing and sharing hair tools. A clinician may inspect the area with magnification, gently test nearby hairs or sample scale when infection is suspected. Management can involve anti-inflammatory treatment, antifungal medicine or removal of mechanical stress, depending on the finding.

Arrange prompt evaluation for pain, marked swelling, pus, fever or redness that is spreading beyond the patch. A shiny scar-like area, rapid development of additional spots, loss involving eyebrows or eyelashes, or tender neck glands also warrants timely assessment. Otherwise, book a routine visit for an unexplained patch that persists or grows.

You might ask whether the follicles appear intact, whether scale should be tested, and whether the distribution suggests immune, mechanical or inflammatory loss. Ask how treatment response will be judged and which changes should prompt an earlier follow-up.