Patchy Hair Loss: Why a Small Bald Spot Should Be Assessed Early
Patchy hair loss can have several causes, so a careful scalp assessment can help guide the right next step.
A small patch should not be ignored
Patchy hair loss can feel very confronting, even when the patch is small. A round or oval bald patch may be linked to alopecia areata, but there are also other causes that can look patchy, including traction, scalp inflammation, infection, scarring alopecias, or broken hairs.
This is why I would not want to guess from a photo alone. I would first check whether the follicles are still intact, whether the margins are defined, and whether there is redness, scaling, tenderness, pustules, black dots, stubble, or signs of scarring.
What I would look for on the scalp
When assessing patchy hair loss, I would look carefully at the scalp surface and the hairs around the patch. The appearance of the follicle openings, surrounding skin, and hair shafts can give useful clues, but it still needs to be considered with the person's history.
Whether the patch appeared suddenly or gradually
Whether there is itching, tenderness, scaling, or redness
Whether hairs are broken, loose, or tapered
Whether there are other patches elsewhere
Whether there has been stress, illness, medication change, or autoimmune history
Why early assessment helps
In many cases, the earlier you understand what may be happening, the clearer the pathway becomes.
The aim is to understand the cause, protect the scalp, and guide the person toward the correct next step.
Frequently Asked Questions
Is a small bald patch always alopecia areata?
No. Alopecia areata is one possible cause, but patchy hair loss can also be linked to traction, infection, inflammation, scarring hair loss, or hair breakage.
When should patchy hair loss be assessed?
It should be assessed early, especially if the patch is spreading, tender, red, scaly, itchy, or there is more than one patch.
Can a trichologist diagnose alopecia areata?
Yes, a trichologist can diagnose alopecia areata. Treatment may require a doctor in severe cases.
What does intact follicle opening mean?
Visible follicle openings can suggest the area may be non-scarring, but this must be interpreted with the scalp signs, hair pattern, and history.
Final Thoughts
Hair and scalp changes can feel very personal, especially when you have already tried products or searched for answers online. The most important thing is to understand what is causing the change before choosing the next step.
A proper assessment can help separate what is normal from what may need further attention, and it can also help guide you toward medical support when that is appropriate.
To book a consultation with Carmen Du Preez Trichology in Perth, visit: www.carmendupreeztrichology.com
About the author
Written by: Carmen Du Preez, IAT Certified Trichologist.
Carmen Du Preez is a Perth-based Certified Trichologist and member of the International Association of Trichologists. She provides trichology consultations for hair loss, hair shedding, thinning hair, and scalp conditions at Carmen Du Preez Trichology in Trinity Arcade, Perth.
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Last updated: 22 August 2026
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