Permanent bald spot: what to know

A smooth or bare patch can follow inflammation, infection, injury, surgery, burns, or repeated pulling. Scarring can destroy follicles, making regrowth unlikely in that area. Other causes, including alopecia areata and scalp ringworm, can produce bald patches without the same kind of permanent follicle loss and may need different care. Clues include redness, scale, itch, tenderness, broken hairs, scarring, or a change in the scalp surface.

Arrange a scalp examination if a patch is new, enlarging, inflamed, or unexplained. A clinician may examine the hairs and scalp closely and may take a sample when infection or scarring is suspected. Avoid tight hairstyles, harsh chemicals, and scratching until the cause is clear. If follicles are no longer active and the area is stable, a hair transplant may be discussed; it is not suitable while active inflammation or infection is present.

Seek prompt review for rapidly spreading loss, scalp pain, pus, crusting, marked redness, or broken hairs with scale. Urgent assessment is appropriate when hair loss follows a significant burn or injury, or when you feel unwell with a suspected scalp infection.

Ask whether the follicles are scarred, whether infection or autoimmune hair loss is possible, what tests are needed, and when restoration treatment would be safe to consider.