Cobblestoning

Cobblestoning refers to a characteristic bumpy or nodular appearance of the scalp where areas of raised scar tissue or irregular follicular units create an uneven surface. It most commonly arises after surgical procedures such as hair transplantation when grafts are placed too superficially, the skin heals with focal fibrosis, or when chronic inflammatory conditions and repeated infections affect the scalp; the pattern resembles a cobblestone surface due to alternating raised and recessed areas.

Diagnosis is clinical, based on inspection and palpation of the scalp, and sometimes supported by dermoscopy or imaging to assess scar depth and follicular structure. Management focuses on prevention through careful surgical technique and wound care, and on treatment options that may include steroid injections, needling or laser therapies to remodel scar tissue, and in selected cases surgical revision or graft repositioning to restore a smoother contour; a specialist such as a dermatologist or hair restoration surgeon can advise the most appropriate approach based on cause and severity.