Scalp scarring and hair loss: what to know

A scarred scalp may look smooth or shiny, with fewer visible follicle openings. Hair loss can be patchy or spread gradually, and symptoms may include burning, pain, itching, redness, scale, pustules, or tenderness. When inflammation destroys a follicle, that specific follicle cannot produce a new hair; however, not every area of hair loss is scarring. [Hair Loss](/symptoms/hair-loss/) can also result from temporary shedding, inherited pattern changes, infection, or immune-related patch loss.

Possible explanations include inflammatory scarring disorders, [Scalp Ringworm](/conditions/scalp-ringworm/), traction from tight hairstyles, and other forms of alopecia. A clinician may inspect follicle openings, use magnification, and sometimes take a small biopsy or other sample to distinguish these causes.

Arrange a dermatology assessment if hair loss is accompanied by scalp pain, burning, pustules, crusting, or a smooth shiny patch. Stop tight braids, extensions, glued styles, and repeated chemical irritation until the scalp has been evaluated. Keep a record of when shedding or patches began, hairstyle tension, illnesses, medicines, and any family pattern of hair loss.

Treatment depends on the cause. Inflammation may need prescription therapy, infection needs antifungal treatment, and traction requires removing the pulling force early. Pattern loss and temporary shedding follow different plans, such as care for [Male Pattern Hair Loss](/conditions/androgenetic-alopecia/), [Female Pattern Hair Loss](/conditions/female-pattern-hair-loss/), or [Telogen Effluvium](/conditions/telogen-effluvium/). Do not apply potent scalp medicines or begin hair-loss treatment without a diagnosis.

Seek prompt review for rapidly expanding patches, active redness, pus, bleeding, thick scale, significant pain, or a tender swollen area. New loss after a tight hairstyle deserves attention if the scalp remains sore or smooth. Urgent care is needed for fever with a spreading scalp infection, facial swelling, breathing difficulty, or a severe reaction to medicine. Earlier assessment is useful when scarring is suspected because treatment aims to protect follicles that remain active.

Ask whether the follicles show scarring, whether a biopsy or fungal test is appropriate, and what diagnosis best fits the pattern. Ask which hairstyles or products to stop, whether inflammation is active, what regrowth is realistic for affected areas, and how progress will be monitored.