- Think perinatal etiology: Patterned, annular or band-like alopecia present since birth—especially with a history of caput succedaneum—should raise suspicion for halo scalp ring.
- Scarring vs non-scarring depends on severity: Most HSR cases are transient, but ischemic damage can lead to permanent cicatricial alopecia.
- History is diagnostic: A detailed labour and delivery history is often sufficient to distinguish HSR from other neonatal alopecias.
- Differentiate from mimickers: Key differentials include aplasia cutis congenita, vacuum-related alopecia, scalp electrode injury, and temporal triangular alopecia, which differ in morphology, location, and history.
- Management is conservative: HSR is benign and does not require systemic evaluation; reassurance is first-line, with early surgical referral considered for significant cosmetic or psychosocial impact.
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