How common are bald patches in scarring alopecia?

Scarring alopecia describes hair loss in which inflammation harms the follicle and may replace it with scar tissue. Patches can look smooth or shiny, and the usual follicle openings may be less visible. Some people notice redness, scale, burning, tenderness, itching, pustules or a band of loss near the hairline. Symptoms differ between types and between active and quieter disease.

Because follicles affected by scarring may not produce hair again, identifying ongoing inflammation matters. A bald patch can have several causes, so a scalp examination is needed before treatment is chosen.

Book a dermatology review promptly, particularly if the patch is enlarging or feels sore, hot or itchy. Take clear photographs in consistent lighting and record changes in symptoms, hairstyles, hair products and treatments. The clinician may use magnified examination and sometimes a scalp biopsy to identify the pattern and activity.

Use gentle washing, avoid tight braids, extensions and harsh chemical processing, and do not scratch or squeeze bumps. Follow prescribed anti-inflammatory treatment carefully; stopping suddenly or changing products without guidance can make it harder to judge activity.

Arrange urgent review for quickly spreading loss, increasing pain, pus-filled bumps, marked swelling, ulcers or heavy crusting. Fever or feeling acutely unwell warrants prompt medical attention. New eyebrow loss or a receding hairline should also be reported because the location can help guide assessment.

Are there signs of active scarring inflammation? Is a biopsy useful? Which hairstyles and products should I avoid? How will we monitor the patch and protect unaffected follicles?