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Scalp Biopsy: Does it Help Diagnose Hair Loss?

Kristin Hall, FNP

Reviewed by Kristin Hall, FNP

Written by Nicholas Gibson

Published 09/20/2021

Updated 09/21/2021

If you’re starting to lose your hair without a clear reason, your healthcare provider may need to take a biopsy from your scalp to determine the root cause of your hair loss and recommend the most appropriate form of treatment.

Getting a scalp biopsy can be a nerve-racking prospect. However, it’s generally a quick process that shouldn’t result in any significant pain or discomfort.

Below, we’ve explained what a scalp biopsy is, as well as how your healthcare provider may use a biopsy to provide a more accurate diagnosis for your hair loss.

Hair loss… The gift that keeps on giving — to men of all ages and backgrounds. It has a range of potential causes, from male pattern baldness to infections, chronic stress, autoimmune diseases and even certain nutritional deficiencies. 

If you’re starting to lose your hair without a clear reason, your healthcare provider may need to take a biopsy from your scalp to determine the root cause of your hair loss and recommend the most appropriate form of treatment.

Getting a scalp biopsy by a hair loss doctor can be a nerve-racking prospect. However, it’s generally a quick process that shouldn’t result in any significant pain or discomfort.

Below, we’ve explained what a scalp biopsy is, as well as how your healthcare provider may use a biopsy to provide a more accurate diagnosis for your hair loss.

We’ve also covered the basics of the scalp biopsy process, as well as what you should expect if you need to get a biopsy to identify the cause of your hair loss.

A scalp biopsy is a minor medical procedure in which a healthcare provider will remove a small piece of your skin from your scalp for testing and analysis. This is different from a trichoscopy, which uses a microscope to examine your follicles up close.

Healthcare professionals use several techniques to do a skin biopsy. These include removing a sample piece of skin using a small circular tool (a punch biopsy) and shaving away a small area of skin using a razor blade (a shave biopsy).

In some cases, the piece of skin may be carefully excised using a surgical scalpel (an excisional biopsy).

A scalp biopsy allows your healthcare provider to provide an accurate diagnosis of any diseases or conditions that affect your scalp. 

For androgenetic alopecia, your healthcare provider may use a scalp biopsy to look for signs of destruction to hair follicles, or to perform a follicular count. 

A biopsy can also show signs of hair damage from autoimmune conditions or scalp disorders.

Your healthcare provider may suggest a scalp biopsy if you’re experiencing hair loss without a clear cause. A scalp biopsy can help your healthcare provider:

  • Look for signs of damage to your hair follicles that may explain hair loss

  • Identify an infection or skin condition that’s affecting your scalp and/or hair

  • Detect inflammation that may be treated to slow down or stop your hair loss

  • Understand what's physically possible in terms of hair recovery and/or regrowth

A scalp biopsy may also be necessary if you have an unusual mole or other type of skin growth on your scalp. 

By performing a biopsy, your healthcare provider may be able to determine if an unusual growth requires further attention.

Many forms of hair loss may be diagnosed after a scalp biopsy, including the following:

  • Male pattern baldness (androgenetic alopecia). This is a type of permanent hair loss that’s caused by a combination of genetic factors and the effects of dihydrotestosterone (DHT), an androgen hormone that can damage your hair follicles. A scalp biopsy may also be used to diagnose female pattern hair loss, a similar form of hair loss that occurs in women.

  • Cicatricial alopecia (scarring alopecia). This term refers to a variety of different forms of hair loss that involve damage to the hair follicles caused by scar tissue. Scarring hair loss often starts small and progresses, in some cases affecting the entire scalp.

  • Telogen effluvium. This is a form of temporary hair shedding that can occur when your hairs rapidly enter into the telogen (rest) phase of the hair growth cycle. It’s triggered by many factors, including stress, fever, surgery and nutritional deficiencies.

  • Alopecia areata. This is a form of non-scarring, patchy hair loss that’s believed to occur due to an autoimmune response. It can range in severity from small, round bald patches to significant hair loss.

  • Dermatophyte-induced alopecia (tinea capitis). This is a form of hair loss caused by tinea capitis (scalp ringworm), a fungal infection that affects the scalp. When severe, it can cause severe inflammation and permanent damage to the hair follicles.

  • Trichotillomania. This type of hair loss develops in people who obsessively, impulsively pull at their hair. It generally begins in a person’s early teens and may develop in people with certain mood and anxiety disorders.

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While getting a biopsy can seem daunting, it’s usually a quick and simple process that isn’t likely to cause significant pain or discomfort. 

A biopsy is a simple, in-office procedure. Your healthcare provider will clean the affected area of your scalp, then remove a small amount of skin using a special device. 

Make sure to follow your healthcare provider’s instructions and stay still throughout the procedure.

Your healthcare provider will usually take a biopsy in the direction of your hair growth. After the procedure, the biopsy sample will be divided into horizontal or vertical sections for analysis. 

In some cases, your healthcare provider may need to take more than one skin sample.

In order to prevent pain, your healthcare provider may use a local anesthetic to numb the area before performing the procedure. 

After the biopsy, your healthcare provider will dress the affected area. Depending on the biopsy technique, the area may be sutured closed. 

Make sure to follow the care instructions provided by your healthcare provider to prevent infection and help your skin recover.

Dermatologists and other healthcare providers that specialize in skin and hair will typically take a biopsy sample when the cause of your hair loss isn’t obvious.

Not all forms of hair loss need to be diagnosed with a scalp biopsy. Depending on your hair loss symptoms, your healthcare provider may use one or several of the following approaches during your visit:

  • Physical examination. Sometimes, hair loss can be diagnosed with a quick physical examination. If you have a receding hairline or thinning near your crown, your healthcare provider may diagnose you with male pattern baldness after looking at your hair.

  • Discussion of your symptoms. Your healthcare provider may ask you about your hair loss symptoms. You may be asked about the amount of hair you lose on a daily basis or when you first started noticing that your hair was falling out.

  • Hair pull test. This type of test involves applying pressure to a small portion of your hair, then counting the number of hairs that are pulled out. Your healthcare provider may use this test to estimate how much hair you’re losing.

  • Hair pluck test. This type of test involves grasping a larger number of your hairs using a surgical clamp, then plucking the hairs out from your scalp. The extracted hairs may be examined to identify the potential cause of your hair loss.

  • Trichogram. After removing hair from your scalp, a dermatopathologist may analyze the hair to look for clubbed hairs, certain hair bulb characteristics or other signs of a specific type of hair loss.

  • Bacterial/fungal culture test. This type of test may be used if you show symptoms of a skin infection, such as tinea capitis. Some scalp infections can cause inflammation and a form of hair loss called fungal alopecia. 

Our guide to what dermatologists do for hair loss goes into more detail about how male pattern baldness and other forms of hair loss are diagnosed and treated. 

Most forms of hair loss are treatable, either through the use of hair loss medication, by treating the underlying cause or by making changes to your hair care habits. 

Depending on the underlying cause of your hair loss, your healthcare provider may recommend one or more of the following hair loss treatment options.

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Use Finasteride and Minoxidil

If your hair loss is the result of male pattern baldness, you can slow it down, stop it from getting worse and even potentially reverse it by using hair loss medication.

Currently, the FDA has approved two medications to treat male pattern baldness. These include finasteride, which works by reducing DHT production, and minoxidil, which works by stimulating hair growth at the scalp level.

Numerous studies have shown that finasteride and minoxidil are effective at preventing hair loss and stimulating hair growth.

In one study, researchers found that the medications are particularly effective when they’re used together, with 94.1 percent of men displaying improvements after using finasteride and minoxidil over a period of 12 months.

We offer finasteride and minoxidil online, with finasteride available following a consultation with a healthcare provider who will determine if a prescription is appropriate. You can also purchase finasteride and minoxidil together in our Hair Power Pack

Treat Any Conditions That Cause Hair Loss

If your hair loss is caused by something other than male pattern baldness, such as rapid weight loss, stress, a fungal infection or scalp inflammation, it’s important to treat the underlying cause before you focus on stimulating hair regrowth. 

Based on your biopsy analysis and results, your healthcare provider may prescribe medication to treat an infection or other scalp issue, or suggest certain changes that you can make to your diet or lifestyle. 

Some scalp conditions may require ongoing care and attention. Closely follow the instructions provided by your healthcare provider. 

Make Changes to Your Hair Care Habits

Sometimes, making small changes to your hair care habits can improve the health of your hair and reduce the severity of your hair loss.

This could mean using hair care products designed to support optimal hair growth, such as our Hair Thickening Shampoo and Thick Fix Conditioner, or changing your diet to include food that promotes healthy hair growth

While changes to your lifestyle are unlikely to reverse male pattern baldness on their own, they may help improve your results from science-based hair loss treatments like finasteride and minoxidil. 

Our guide to the best treatments for thinning hair goes into more detail about how you can slow down, stop and reverse the effects of male pattern baldness and other forms of hair loss. 

Hair loss treatments, delivered

A scalp biopsy is a quick, simple procedure that involves removing a sample of skin from your scalp for testing and analysis. 

Your healthcare provider may suggest a biopsy if you have hair loss without a clear, obvious cause, or to get more information about a skin condition. 

Getting a scalp biopsy typically only takes a few minutes. After the procedure, it’s important to closely follow your healthcare provider’s instructions to help your skin recover quickly. 

Your healthcare provider will recommend an appropriate scalp treatment for hair loss option based on the results of your biopsy test, your symptoms, personal needs and other factors.

Worried about your scalp health? You can learn more about rashes, hair loss and other issues that may affect your scalp in our detailed guide to the most common scalp conditions

9 Sources

  1. Skin Biopsy. (2020, December 3). Retrieved from https://medlineplus.gov/lab-tests/skin-biopsy/
  2. Vidal, C.I. (2015, July-August). Overview of Alopecia: A Dermatopathologists Perspective. Missouri Medicine. 112 (4), 308–312. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170065/
  3. Hughes, E.C. & Saleh, D. (2021, June 8). Telogen Effluvium. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430848/
  4. Pickett, H. (2011, November 1). Shave and Punch Biopsy for Skin Lesions. American Family Physician. 84 (9), 995-1002. Retrieved from https://www.aafp.org/afp/2011/1101/p995.html
  5. Zito, P.M., Bistas, K.G. & Syed, K. (2021, March 27). Finasteride. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513329/
  6. Badri, T., Nessel, T.A. & Kumar, D.D. (2021, April 13). Minoxidil. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482378/
  7. Hu, R., et al. (2015, September-October). Combined treatment with oral finasteride and topical minoxidil in male androgenetic alopecia: a randomized and comparative study in Chinese patients. Dermatologic Therapy. 28 (5), 303-308. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/dth.12246
  8. Ho CH, Sood T, Zito PM. Androgenetic Alopecia. updated 2021 aug 11. In: StatPearls internet. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430924/
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Kristin Hall, FNP

Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership. 

She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH

Certified through the American Nurses Credentialing Center, she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare. 

Kristin is a St. Louis native and earned her master’s degree in Nursing from St. Louis University, and is also a member of the American Academy of Nurse Practitioners. You can find Kristin on LinkedIn for more information.

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