To me, it looks like an irritation either from something he's in contact with or from scratching. Scratching could be caused by earmites, fleas, an allergy, etc. I agree that a vet visit might not be a bad idea.
It could maybe be ringworm, which would explain the hair loss. An easy way to test for this is to use a blacklight and see if the hair in the area glows a flourescent green color. Though testing this way isn't 100% accurate as the hair might not glow and it could still be ringworm, most of the time if it does glow it is. Good luck!!!
There really isn't any hair loss though. That is how the area right in front of a cats ears normally look, minus the red bumps of course. If it was ringworm you would see the circle. It definately looks likehis ears are itchy. Could be mites, or an ear infection deep in his ear canal.