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Hair problem
A patch in the hair, where the scalp is visible, can have several causes, and some call for early assessment. Here we explain what usually lies behind it, which signs should not wait and what the doctor assesses at the appointment.
Reviewed by Dr Michelle Campagnoli, clinical director
How to recognise it
There are many causes for a patch in the hair, and only examining the scalp can tell them apart. These signs help you understand what to describe to the doctor and whether you should come sooner.
Tick what you recognise
Tick the signs you recognise in your case. This is not a diagnosis, it is only meant to give you an idea.
Recognise some of these signs? Patches can have several causes. Only a medical assessment can say for sure what is going on.
Several signs call for attention. The sooner you are assessed, the easier it is to understand the cause and choose what to do. Only a medical assessment confirms.
Book an assessment consultationSudden and heavy shedding, patches that appear quickly, a painful scalp, sores, marked flaking, redness or scarring should be seen without delay.
Parting and crown. This is where the scalp shows most. The doctor observes whether the hair is finer or whether there is a well-defined patch.
Sides and nape. Patches here are common in several causes. The doctor looks at the edges, the skin and the hairs next to the patch.
Hairline. The skin and the hairline matter: the doctor observes whether there is recession, redness or scarring.
Why it happens
Patches do not have a single cause, and appearance alone is not enough to tell them apart. Choose a hypothesis to see what usually makes it worse and what helps.
It usually causes round or oval patches of smooth skin, without pain. It has an immune origin and the follicle is not usually destroyed, so the hair may regrow. The dedicated page explains it in detail.
Letting time pass without confirming, while new patches appear.
Assessment to confirm and follow the progress, which is unpredictable.
Tight hairstyles or extensions can cause patches in areas of tension, and the habit of pulling or plucking the hair (trichotillomania) can cause patches in an irregular pattern. The doctor assesses what is going on without judgement.
Keeping up the tension or the habit for a long time, because the area may not recover.
Reduce the tension early and talk about it openly at the appointment.
Scalp ringworm is a fungal infection that can cause patches with flaking, redness and itching, sometimes with swollen and painful areas. It is not treated with topical products alone and calls for assessment without delay.
Putting off the appointment, because inflammatory forms can leave permanent patches.
Confirm the cause and treat with medical guidance.
These are rare conditions in which inflammation destroys the follicle and the area is left without hair permanently. They can cause itching, burning or pain, with smooth skin and no pores, and call for early assessment.
Waiting, because once the follicle is scarred the hair rarely regrows.
Early assessment, with trichoscopy and, if necessary, a biopsy.
When hair falls out all over the scalp, it can look as though there are patches. It usually has causes such as stress, illness, deficiencies or thyroid changes, and the doctor assesses whether tests are worthwhile.
Taking supplements on your own, without knowing what is missing.
Understand the whole picture with the doctor and treat the cause, if there is one.
When not to wait
Not all patches progress at the same pace. These signs help you understand whether you can book calmly or should come without delay.
What it looks like. A patch of smooth skin, with no pain, flaking or redness.
How it evolves. It may stay the same, increase or even regrow, and this is hard to predict.
What the clinic does. The doctor observes the scalp, confirms the type of patch and explains what you can expect.
Follow-up. Even when stable, it is advisable to follow up with reviews.
What it looks like. Patches that appear or grow quickly, sudden and heavy shedding, or areas with scarring.
Attention. Pain, sores, scabs, marked flaking, redness or burning call for assessment without delay.
What the clinic does. The doctor examines the scalp, may use trichoscopy and, if necessary, request tests or a biopsy.
Say so at the appointment. When it appeared, whether it has changed, whether it hurts or itches and the products or hairstyles you use.
Noticed a patch in your hair? Book an assessment appointment, so the doctor can understand what is going on and whether there are signs that should not wait.
Book an assessment consultationWhat the clinic can do
The first step is to understand the cause of the patches, and some causes call for specific medical treatment or dermatology. After the assessment, the doctor may propose one of these treatments as support for the plan. Results vary from person to person and science is still studying these treatments, so the doctor explains what is known and what you can expect before any decision.
Regeneration
Vitamins, amino acids, minerals and hyaluronic acid, which may help nourish the scalp and the follicle environment.
Suitable when
the doctor considers that scalp nourishment may support the plan.
Find out more→
Regeneration
Platelet-rich plasma, obtained from your own blood, which may help stimulate the follicle in some cases. The doctor first assesses whether it is appropriate.
Suitable when
the cause has already been clarified and the doctor considers that stimulating the follicle may support the plan.
Find out more→
Advanced regeneration
Regenerative solution that may help support the scalp and the follicle, with a variable response.
Suitable when
the doctor considers it useful to reinforce the plan with a regenerating active ingredient.
Find out more→What about oral therapy and other medical options? When there is an infection, inflammation or alopecia that calls for specific treatment, the doctor explains the options, chooses them after the assessment and, if useful, after tests. When the case warrants it, she may refer you to dermatology. Results vary from person to person.
What the journey looks like
No treatment starts without an assessment consultation with the doctor. This is how it works.
The doctor asks when the patch appeared, whether it is growing, whether there is pain, itching or flaking, which hairstyles and products you use, and examines the scalp and the edges of the patch.
If useful, she observes with trichoscopy, requests tests or, in selected cases, a biopsy, and looks for causes such as infection or traction.
She treats or refers the cause and, if appropriate, assesses whether any of the clinic's options can support the plan.
We see the scalp again after some time and adjust the plan, because progress varies from case to case.
Day to day
There are simple measures that protect the scalp while you wait for the appointment and throughout the plan.
The golden rule
Patches with symptoms or that grow quickly call for early assessment. Treating before knowing the cause may delay the right treatment.
A photograph from time to time helps you see whether it changes.
In practice: photograph the area in the same light and bring the images to the appointment.
An irritated scalp needs care.
In practice: wash with a gentle shampoo and brush slowly.
Exposed skin burns easily.
In practice: protect the patch from the sun with a hat or a suitable sun protection product.
Hairstyles, habits and products matter.
In practice: also mention extensions, dyes and any habit of touching or pulling the hair.
Touching the patch can irritate the skin and make the situation worse.
In practice: if you feel an urge to pull your hair, talk about it at the appointment, without worry.
Oils, onion or other products may irritate and delay the right cause.
In practice: avoid applying products without medical advice.
Constant tension weakens the follicle.
In practice: avoid very tight ponytails, braids and extensions.
Taking supplements on your own may not solve the problem and may do harm.
In practice: talk to the doctor before taking supplements.
Who will look after you
At Luxmed, the first step is always an assessment appointment with Dra. Michelle Campagnoli. She observes the scalp, works out what is going on, requests tests if useful and designs the plan with you.
Hair medicine
What to describe to the doctor and when not to wait.
Read the article →
Hair medicine
From alopecia areata to traction: what the doctor assesses.
Read the article →
Hair medicine
Trichoscopy, tests and, when necessary, a biopsy.
Read the article →Other hair problems
Book a consultation
Choose how you prefer to get in touch. We will arrange the assessment consultation with Dr Michelle Campagnoli.
New Life Miraflores, Algés · Office Center, R. Santa Teresa do Menino Jesus n.º 6, 9.º C, 1495-048
Your details are used only for this contact. Any treatment depends on a prior medical assessment.
There are several causes, such as alopecia areata, traction, scalp ringworm, the habit of pulling the hair, scarring alopecias and diffuse shedding. Appearance alone is not enough to tell them apart, so the doctor examines the scalp.
No. Alopecia areata usually causes smooth, well-defined patches, but other causes can look similar. Only a medical assessment can tell them apart.
As soon as you notice the patch. Sudden and heavy shedding, patches that appear or grow quickly, pain, sores, flaking, redness or scarring should be seen without delay.
It depends on the cause. In some situations the follicle remains and the hair may regrow. In others, such as scarring alopecias, the follicle is damaged and it is more difficult. The doctor explains what is realistic for you.
It is a group of conditions in which inflammation destroys the follicle and the scalp becomes smooth, without pores. They call for early assessment, because treating before scarring occurs offers more options.
Yes. It is a fungal infection that can cause patches with flaking, redness and itching. It does not usually resolve with topical products alone, and inflammatory forms can leave permanent patches.
The doctor asks when the patch appeared, examines the scalp and may use trichoscopy. If useful, she requests tests or, in selected cases, a biopsy.
Depending on the case: hair NCTF, hair PRP or hair exosomes, as support for the plan, once the cause has been clarified. None is chosen before the assessment appointment.
Yes. It is a well-known situation and the doctor handles the subject naturally. Talking about it helps choose the best path.
It is not advisable. Without knowing the cause, products may irritate the scalp and delay the right treatment. It is best to book an assessment.
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This page is based on the sources below and was reviewed by Dr. Michelle Campagnoli. Last updated on .
The assistant does not give diagnoses or replace a consultation. The plan and cost of any treatment are set at the medical assessment.