Can scalp injury take place?

Answered by Julie Holdom after a question from a parent.

My name is Julie, and I assist Amanda with her email. I am also a Trichster,
and a nurse, so I'll try to answer your question as best I can.
The act of pulling out hair from the scalp can cause a localized inflammatory
reaction that is similar to what happens if you have a cut. The body sends
white blood cells and fluids to the area, which would cause the scalp to
become softer & swollen. I would also expect it is warm to the touch and
reddened. If your daughter tends to be atopic (i.e., asthma, excema, and/or
allergies) this response could be more pronounced. Also, depending on your
daughters age, her scalp bones may not fully be fused, causing an extra
degree of softness on top of the reaction. I would also imagine that if your
daughter pulls hair in clumps, rather than one at a time, it may further the
reaction.
From your description, I don't think you need to worry about any serious or
permanent damage. You might discuss with your doctor about the use of a
steroidal cream to help with the inflammation, and your doctor may also
consider a referral to a dermatologist, or consider doing some other studies
just to make sure there is nothing else going on physiologically.