# Red flags in a hair consultation: when to refer to a GP

> The signs in a hair and scalp consultation that mean a client should see a GP first, how to raise it kindly, and how to record the referral in your notes.

- URL: https://www.trichollective.net/blog/red-flags-in-a-hair-and-scalp-consultation
- Topic: Consultations and referrals
- Author: Trichollective editorial team (Edited and checked before publication)
- Published: 2026-10-09
- Last updated: 2026-10-09
- Clinical review: in progress

Most clients who sit in your chair with a hair or scalp worry do not need a doctor. A few do, and spotting them early is the most valuable thing a cosmetic or clinical practitioner can do. This is a working checklist for the consultation room.

## The short answer

Refer a client to their GP before any treatment if you see patchy or sudden hair loss, shiny or scarred patches, pain, burning or pus on the scalp, scaling with broken hairs in a child, a changing mole or sore that will not heal, or hair loss alongside tiredness, weight change or irregular periods. Record what you saw, what you advised and that the client agreed.

## Key points

- A red flag is a sign that the cause may be medical, not a reason to panic. Your job is to notice it and refer, not to diagnose it.
- Scarring hair loss is the most important one to catch early, because hair lost to scarring does not grow back.
- Children with scaly patches and broken hairs should see a GP, because scalp ringworm needs prescribed treatment.
- Write the referral into your case notes in plain words: what you saw, what you said and what the client chose to do.

## Why do red flags matter in a hair consultation?

Hair and scalp care is shared between three groups of people: cosmetic professionals such as hairdressers, barbers and head spa therapists; clinical practitioners such as trichologists; and medical doctors, including GPs and dermatologists. Each group sees clients the others never meet, which means the hairdresser or trichologist is often the first person to notice that something has changed.

A red flag is a sign that the cause of a client's hair or scalp problem may be medical. It does not mean something serious is happening, and it is not a diagnosis. It means the next step should be a conversation with a doctor before any cosmetic or clinical treatment goes ahead.

Handled well, a referral protects the client, protects your professional reputation and usually brings the client back to you with a clear plan once a medical cause has been ruled out or treated.

## Which signs mean a client should see a GP first?

Use this list as a prompt during the consultation. Our public guide on [when hair shedding is worth a GP visit](https://www.trichollective.net/guides/hair-shedding-when-to-worry) covers the same ground for clients. If any of these are present, pause treatment and suggest the client speaks to their GP.

### Changes in the pattern of hair loss

- Sudden hair loss, or loss that is getting quickly worse over weeks rather than months.
- Round or oval bald patches, or loss of eyebrows, eyelashes or beard hair.
- Hair loss in a child.

### Changes in the skin of the scalp

- Areas where the scalp looks shiny, smooth or scarred, and where follicle openings seem to have disappeared.
- Redness, scaling or tiny bumps around the follicles at the edge of a patch of hair loss.
- Pain, burning, tenderness or itching that keeps the client awake.
- Pustules, pus, crusting or open sores.
- A mole, lump or sore on the scalp that is new, changing, bleeding or not healing.

### Signs elsewhere in the body

- Hair loss together with tiredness, feeling cold, weight change or heavy periods.
- In women, hair thinning together with irregular periods, new acne or new hair growth on the face or body.
- A recent illness, operation, new medicine or a big change in diet, especially if the client has not told their doctor about the hair loss.

## Why is scarring hair loss the one not to miss?

Some types of hair loss cause inflammation that destroys the hair follicle and replaces it with scar tissue. These are called [scarring or cicatricial alopecias](https://www.trichollective.net/glossary/scarring-alopecia), and they include frontal fibrosing alopecia and lichen planopilaris. Hair lost to scarring does not grow back, so the aim of medical treatment is to stop the process as early as possible.

The early signs can be subtle. Look for a hairline that is creeping back with a smooth, pale band of skin in front of it, loss of eyebrows, redness or scale around the follicles at the edge of a patch, or a client who mentions itching, burning or tenderness in the same area. If you use trichoscopy, missing follicle openings are an important clue.

You do not need to name the condition. Telling the client that you have noticed changes in the skin that a doctor should look at is enough.

## What should you do when a child has scaly patches?

Scalp ringworm, also called tinea capitis, is a fungal infection that is most common in children. It can cause scaly, itchy patches, broken hairs that look like black dots, and sometimes a tender, swollen area. It spreads easily between children and through shared combs, brushes and hats.

Scalp ringworm needs antifungal medicine that a doctor prescribes, so creams and shampoos alone are not enough. If you see these signs in a child, do not treat or cut through the area. Suggest the parent or carer takes the child to their GP or pharmacist, and clean or set aside any tools that touched the scalp.

## How do you raise a referral without frightening the client?

Clients remember how a referral was said as much as what was said. These habits help:

- Explain what you noticed in plain words, for example "the skin here looks different from the rest of your scalp".
- Say why it matters: "this is something a doctor should look at before we do any treatment".
- Avoid naming conditions or guessing at causes. Leave diagnosis to the doctor.
- Offer something practical, such as a short written note of what you saw, which the client can take to the appointment.
- Tell the client you would be glad to see them again once they have spoken to their GP.

If a client decides not to see a doctor, that is their choice. You can still decline a treatment that you believe is unsafe until a medical cause has been ruled out.

## What should go in your case notes?

Good notes protect both you and the client. After any consultation where you raise a red flag, record:

- The date, and what the client told you about their hair, scalp and health.
- What you saw, described rather than diagnosed, for example "smooth, pale patch about 2cm across at the left temple, no visible follicle openings".
- Photographs, if the client has agreed in writing.
- What you advised, in the words you used.
- What the client decided, and whether any treatment went ahead.

Keep notes securely and in line with UK and Irish data protection law, because information about someone's health is special category data.

## How does a referral network help?

The quickest referrals happen when you already know who to send someone to. Many trichologists and cosmetic professionals build relationships with local GPs, dermatologists and each other, so a client can move from the salon chair to the right professional without starting again.

The [Trichollective directory](https://www.trichollective.net/directory) lists cosmetic, clinical and medical hair and scalp professionals across Ireland and the UK. Members also use the community's case rounds to ask colleagues from other disciplines whether a case needs a referral, without sharing anything that identifies the client.

## Common questions

### Can a hairdresser tell a client they have alopecia?

A hairdresser should not diagnose any condition. It is helpful and appropriate to describe what you have noticed, such as a round patch or a change in the skin, and to suggest the client speaks to their GP.

### Should I continue a treatment while a client waits to see their GP?

If you have seen a red flag, it is safest to pause any treatment on the affected area until a doctor has seen it. Gentle cleansing may be fine, but avoid anything that could irritate the skin or hide changes the doctor needs to see.

### Is a trichologist able to refer a client to a dermatologist?

In most cases the client will need to see their GP first, who can refer them to a dermatologist through the NHS or HSE. Clients can also choose to book a private dermatologist directly. A trichologist can write a short letter describing what they saw to support either route.

### What counts as sudden hair loss?

There is no exact cut-off, but hair loss that the client notices over days or a few weeks, that leaves bald patches, or that is clearly getting worse quickly should be checked by a GP.

## Sources

- [NHS: Hair loss](https://www.nhs.uk/conditions/hair-loss/)
- [HSE: Hair loss](https://www2.hse.ie/conditions/hair-loss/)
- [NHS: Ringworm](https://www.nhs.uk/conditions/ringworm/)
- [DermNet: Frontal fibrosing alopecia](https://dermnetnz.org/topics/frontal-fibrosing-alopecia)
- [DermNet: Alopecia areata](https://dermnetnz.org/topics/alopecia-areata)

_This is general information, not medical advice. If you are worried about your hair or scalp, speak to your GP._