What causes bald patches?

Smooth, round areas without scale may occur in alopecia areata, an immune condition that targets hair follicles. Scaling, broken hairs, itching or swollen glands can suggest scalp ringworm, which is an infection needing medical treatment. Shiny skin, redness, burning or loss of follicle openings can point to scarring alopecia, where inflammation may permanently damage follicles. Repeated tension from tight hairstyles or deliberate or automatic pulling can also create irregular gaps. The pattern, scalp surface, broken hairs and changes in nails help a clinician narrow the cause.

Take a clear photograph when you first notice a patch and record whether it is growing, itchy, sore or scaly. Avoid tight braids, harsh chemical treatments and pulling while the cause is unclear. Do not share combs, brushes, hats or pillowcases if infection is possible, and arrange assessment before using steroid or antifungal products on a child. Treatment may involve prescribed medicine, behaviour support, or a hair-restoration discussion after the underlying condition is controlled.

Book a medical review for any unexplained bald patch, especially if it is enlarging or joined by scalp pain, pus, heavy scaling, broken hairs or inflamed skin. Seek prompt advice when the scalp looks shiny or scarred, or when eyelashes or eyebrows are also thinning. Early review matters because some inflammatory causes can damage follicles, while an infection may spread to close contacts.

Ask which pattern your scalp shows, whether examination or testing is needed, and whether the follicles appear scarred. Ask how soon treatment should start, which hairstyles to avoid, and how progress will be checked before considering hair transplant options.