What do bald patches feel like with scarring alopecia?

Most people with Scarring Alopecia notice bald patches alongside some combination of itch, soreness, burning, stinging or sensitivity. The scalp may look red, darker or lighter than nearby skin, and its surface can develop scale, crusts, pustules or a smoother, shiny texture. These changes reflect inflammation around hair follicles, which can damage follicles if it continues.

The symptoms and appearance vary between types of scarring alopecia. A clinician may examine the scalp closely and sometimes take a small sample to identify the pattern and guide treatment.

Book a dermatology appointment promptly for a new or expanding patch, especially when discomfort, redness, scaling or pimples are present. Avoid tight hairstyles, chemical processing and scratching until you have advice. Photograph the area and record changes in pain, itch, shedding or scalp texture.

Seek prompt care for rapidly spreading hair loss, marked tenderness, pus, bleeding, thick crusting or fever. Painful inflammation can need timely treatment to protect remaining follicles. Eye-area hair loss, facial swelling or feeling acutely unwell also warrants urgent assessment.

What signs suggest scarring rather than non-scarring hair loss? Is a scalp biopsy needed? Which treatment can calm the inflammation, and how will we monitor for further follicle damage?