Bald Spots in Black Hair: What to Know

A smooth patch, a scaly patch with broken hairs, and thinning along areas under tension suggest different processes. Hair texture does not determine the cause, but styling practices, product exposure, and the visibility of redness on deeply pigmented skin are relevant to the examination.

Alopecia areata often presents with clearly defined smooth patches, although short hairs may remain. Scalp ringworm commonly presents with scaling, itch, tenderness, or broken hairs and can spread between people. Repeated pulling from tight braids, extensions, locs, ponytails, or headwear may cause traction-related loss, especially near stressed margins.

Shine, loss of visible follicle openings, persistent burning, bumps, or tenderness can signal scarring inflammation. Early assessment matters because hair may not regrow normally once follicles are replaced by scar tissue.

Pause tight or heavy styles and avoid chemical relaxers, heat, adhesives, and vigorous brushing on the affected area. Wash gently, avoid sharing combs or head coverings, and do not apply steroid creams to a possibly infected scalp unless prescribed.

A dermatologist may examine the scalp closely, pull or inspect hairs, test for fungus, or take a small sample when scarring is suspected. Treatment must match the cause. A hair transplant is generally considered only after the diagnosis is established and any active inflammation or infection is controlled.

Book prompt care for an enlarging patch, scalp pain, pus, crusting, swelling, marked itch, or signs of scarring. Seek urgent help if scalp swelling is accompanied by fever, rapidly spreading redness, facial swelling, or feeling seriously unwell. Children with a scaly patch and broken hairs should be assessed because scalp ringworm usually needs prescription treatment.

Ask whether the follicles look intact, whether fungal testing or a scalp biopsy is appropriate, which styling practices to change, and how treatment will be monitored. Describe itching, scale, pain, shedding elsewhere, recent illness, medicines, and anyone at home with a similar scalp problem.