Balding in spots: causes, care and warning signs

Possible explanations include alopecia areata, a fungal scalp infection, traction from tight hairstyles, repeated pulling, inflammation or scarring disorders. The outline, scaling, broken hairs and condition of the exposed skin help distinguish them.

A smooth, round patch with normal-looking skin can occur with alopecia areata. Scale, crust, tenderness or short broken hairs may accompany infection or inflammation. Loss along the hairline may follow sustained tension from braids, extensions or tightly secured styles.

Shiny skin, loss of visible follicle openings, burning or pustules raises concern for scarring damage. A clinician may examine the scalp closely, test loose hairs, take a scraping when fungus is suspected or occasionally sample the skin.

Photograph the patch in consistent lighting and note whether it is enlarging, itchy, sore or scaly. Pause tight hairstyles, chemical straightening and vigorous brushing. Use gentle shampoo, avoid scratching, and do not share combs or headwear if infection is possible.

Arrange a dermatology visit rather than starting leftover steroid or antifungal products. Treatment depends on the cause; a medicine that calms inflammation will not replace appropriate antifungal care, and an unsuitable product can obscure the examination.

Seek prompt medical assessment for a painful, swollen or draining scalp; fever; rapidly expanding loss; or patches in a child with scale and broken hairs. Book an appointment soon if the skin looks scarred, eyebrows or eyelashes are affected, or new patches continue to appear.

Sudden shedding across the whole scalp, nail changes, recent illness, new medicines or symptoms of thyroid or nutritional problems are also useful reasons for a broader medical review.

Ask whether the follicles appear intact, whether a fungal test or skin sample is needed, and which hair practices should stop. Clarify how treatment will be monitored and what change should trigger an earlier follow-up.