Head scars and hair loss: what to know

A smooth, shiny patch with few or no visible follicle openings may represent scarring alopecia, in which inflammation or injury destroys follicles. A raised scar can follow trauma, surgery, burns, infection, or repeated pulling. Hair loss without scarring may instead form round patches, a widening part, a receding hairline, or diffuse shedding after illness or stress. Scalp ringworm can cause scale, broken hairs, and inflamed areas. These patterns overlap, so a close examination is needed.

Book a dermatology assessment when a scarred patch is enlarging, tender, itchy, red, or shedding hair. Bring a list of medicines and describe prior injuries, hairstyles, extensions, tight headwear, illnesses, and timing of the loss. Avoid tight traction, chemical processing on irritated skin, and scratching. Do not start finasteride or another hair-loss medicine without discussing the diagnosis, pregnancy considerations where relevant, and possible side effects with a clinician.

Seek prompt attention for rapidly expanding loss, pus, warmth, severe pain, fever, bleeding, or a newly swollen scalp. Early treatment can matter when active inflammation is damaging follicles. Sudden patchy loss, eyebrow changes, or loss with widespread rash also deserves timely review.

Ask whether the follicles appear scarred, whether a dermatoscope or biopsy is needed, what may be driving the loss, and which treatments could protect remaining follicles or improve the appearance of established scars.