What should you know about central centrifugal scarring alopecia?

Inflammation around the follicle can destroy its growth structures. The centre of the scalp may look less dense, then the area can widen toward the sides. Tenderness, itch, burning, scaling, or small bumps may accompany the loss, although some people notice only a change in density. A smooth, shiny scalp with fewer follicle openings suggests established scarring rather than simple shedding.

Several hair-loss conditions look similar. [Bald Patches](/symptoms/bald-patches/) can have causes that do not scar, while [Frontal Fibrosing Alopecia](/conditions/frontal-fibrosing-alopecia/) has a different distribution and clinical pattern.

Arrange a dermatology appointment when the centre part is widening or the scalp feels inflamed. Avoid tight braids, extensions, harsh chemicals, frequent high heat, and scratching over the affected area. Keep a dated photograph in consistent lighting to show change, and bring details of styling routines, shedding, and any scalp products. Treatment aims to calm active inflammation and protect remaining follicles; a dermatologist may discuss anti-inflammatory medicines or a [Steroid Injection Into The Skin](/treatments/injectables/intralesional-steroid-injection/) when appropriate.

Seek prompt care for fast progression, severe pain, pus, crusting, bleeding, or pronounced swelling. Fever or redness spreading beyond the scalp warrants urgent attention. Do not wait for complete baldness before seeking review, because the examination needs to distinguish active inflammation from established scar.

Is the hair loss scarring, and is inflammation still active? Would a scalp biopsy clarify the diagnosis? Which styling changes matter most for me, and how will we judge whether treatment is protecting remaining follicles?