Scalp scars
Scalp scars may follow injury, burns, surgery or conditions that destroy hair follicles. Hair cannot regrow from a destroyed follicle. A hairless area that appears scarred may still have active disease and should not automatically be treated as an old, stable scar.
What you may notice
- Smooth or shiny hairless skin
- Reduced visible follicle openings
- Raised or indented tissue
- Tightness, tenderness or itching
- Redness, scaling or spreading loss at the edge
Why it can happen
Deep injury can replace follicles with scar tissue. Inflammatory diseases such as lichen planopilaris can progressively destroy follicles. Infection and previous medical treatment are other possible causes. Ongoing inflammation may extend beyond the visibly scarred area.
What may help
The first priority is identifying and controlling active disease. Hairpieces or styling can provide camouflage. Selected stable scars may be suitable for surgical revision or transplantation, but blood supply, scar characteristics and recurrence risk affect results. Surgery does not reverse the underlying scarring disorder.
When to consult
Seek dermatology assessment for spreading loss, pain, itching, redness, scaling, pustules or an uncertain cause. Specialist assessment of disease activity and scar stability should precede restoration procedures.
Evidence and sources
- DermNet. Hair loss [Internet]. Auckland: DermNet; 2023 [cited 2026 Nov 7]. Available from: https://dermnetnz.org/topics/hair-loss (new tab)
- National Health Service. Scars [Internet]. London: National Health Service; 2023 [cited 2026 Nov 7]. Available from: https://www.nhs.uk/conditions/scars/ (new tab)
- DermNet. Keloid and hypertrophic scar [Internet]. Auckland: DermNet; 2022 [cited 2026 Nov 7]. Available from: https://dermnetnz.org/topics/keloid-and-hypertrophic-scar (new tab)
- DermNet. Lichen planopilaris [Internet]. Auckland: DermNet New Zealand Trust; [cited 2026 Nov 7]. Available from: https://dermnetnz.org/topics/lichen-planopilaris (new tab)
- British Association of Plastic, Reconstructive and Aesthetic Surgeons. Hair transplant surgery [Internet]. [cited 2026 Nov 7]. Available from: https://www.bapras.org.uk/public/patient-information/surgery-guides/hair-transplant-surgery (new tab)