What should you know about a scar bald spot?

Scarring alopecia can leave skin smooth, shiny, lighter, darker, or firmer than the surrounding scalp because the follicle openings have been replaced by scar tissue. A healed injury, burn, infection, inflammation, or previous procedure may be relevant. A bald patch is also seen with alopecia areata, where the scalp surface usually remains visible rather than scarred, and with scalp ringworm, which may cause scale, broken hairs, tenderness, or swollen areas.

A clinician examines the surface, follicle openings, hairs at the edge, and nearby skin. They may use a magnifying instrument and, when the diagnosis is uncertain, discuss a small scalp sample.

Arrange a dermatology assessment, especially if the patch is enlarging or new areas appear. Take a clear photograph in consistent lighting and note when the change began, any injury or infection, itching, pain, scale, or treatments used. Avoid tight hairstyles, scratching, harsh chemical products, and unapproved steroid or hair-growth products on the area.

Treatment depends on whether follicles are still active and whether inflammation or infection is present. Once a scar is stable, a hair transplant may be discussed for suitable areas, but it cannot restore a follicle that remains inflamed or damaged.

Seek prompt medical care if the patch is rapidly expanding, painful, warm, draining, crusted, or associated with fever. Arrange an earlier review for bleeding, an ulcer, marked tenderness, or a new changing spot on the scalp. These features need examination rather than cosmetic treatment alone.

Could this be scarring alopecia, alopecia areata, or scalp ringworm? Are the follicle openings still present? Would a scalp examination or biopsy clarify the cause? Should inflammation or infection be treated before discussing hair restoration?