Content
Over 90% of users saw increased regrowth or reduced hair loss in clinical trials
Hair loss has a range of potential causes, from male pattern baldness, infections, and chronic stress to autoimmune diseases and even certain nutritional deficiencies. When the culprit is unclear, experts may use a scalp biopsy.
Your healthcare provider might need to take a biopsy to determine a particular alopecia, disorder, or autoimmune condition, as well as to formulate a treatment plan.
We’ll explain what a scalp biopsy for hair loss is and go over how your healthcare provider may use a biopsy to provide a more accurate diagnosis for hair thinning or excess shedding.
Content
A scalp biopsy is a minor medical procedure where a healthcare provider removes a small piece of skin from the scalp for testing and analysis. This is different from a trichoscopy, which uses a microscope to examine hair follicles up close.
Healthcare professionals use several techniques to do a skin biopsy. These include removing a sample piece of skin with 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 lifted using a surgical scalpel (called an excisional biopsy). In that case, you might need sutures to close the wound.
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.
To prevent pain, your provider might use a local anesthetic to numb the area before performing the procedure.
A scalp biopsy allows medical professionals to provide an accurate diagnosis of any diseases or conditions affecting your scalp. 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 hair follicles that may explain hair loss
Identify an infection or skin condition affecting the scalp or hair
Detect inflammation that may be treated to slow down or stop hair loss
Understand what’s physically possible in terms of hair recovery or regrowth
A scalp biopsy might also be necessary if you have an unusual mole or another type of skin growth on your scalp that needs further attention.
Beyond that, a biopsy can show signs of hair damage from autoimmune conditions or scalp disorders. For androgenetic alopecia (male pattern baldness), your provider might use a scalp biopsy to look for destruction to hair follicles or to perform a follicular count to see how many active, open hair follicles you have.
Many forms of hair loss may be diagnosed after a scalp biopsy, including:
Male pattern baldness. This type of hair loss is caused by a combination of genetic factors and the effects of dihydrotestosterone (DHT), an androgen hormone that can damage 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 includes various forms of hair loss involving 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 form of temporary hair shedding happens when hairs rapidly enter into the telogen (rest) phase of the hair growth cycle. Telogen effluvium is triggered by many factors, including stress, fever, surgery, and nutritional deficiencies.
Alopecia areata. This form of non-scarring, patchy hair loss is thought to occur due to an autoimmune response. Alopecia areata can range in severity from small, round bald patches to significant hair loss.
Dermatophyte-induced alopecia. This type of hair loss is caused by tinea capitis (scalp ringworm), a fungal infection. When severe, it can result in severe inflammation and permanent damage to hair follicles.
Trichotillomania. This hair loss develops in people who obsessively and impulsively pull out their hair. It generally starts during the early teen years and may be more likely to occur in those with certain mood and anxiety disorders.
The scalp is usually biopsied in one of two ways:
Shaving the hair and taking a tissue sample
Punch biopsy
The shaving biopsy removes most of the hair shaft while preserving the root, so hair will grow back at the biopsy site in keeping with your hair growth patterns.
Punch biopsies remove the hair follicle in its entirety, so typically, the hair harvested for this biopsy doesn’t grow back. Punch biopsies are typically closed with sutures, so the patient shouldn’t have any visible hair loss from the procedure.
Keep in mind, hair damaged during a biopsy may also be lost as alopecia’s progress continues.
If you’re concerned about losing additional hair from a biopsy, consider requesting that the hair be harvested in a location of your choosing.
Not all forms of hair loss need to be diagnosed with a scalp biopsy.
Depending on your hair loss symptoms, your dermatology or healthcare provider may use one or several of these tests to determine your cause of hair loss:
Physical examination. Sometimes, hair loss can be diagnosed with a quick physical exam. If you have a receding hairline or thinning near your crown, your provider might diagnose you with male pattern baldness after simply looking at your hair.
Discussion of your symptoms. Your healthcare provider may ask about your hair loss symptoms, such as the amount of hair you lose on a daily basis or when you first started noticing your hair falling out.
Hair-pull test. This involves applying pressure to a small section of hair, then counting the number of hairs that are pulled out. Your provider may use a hair-pull test to estimate how much hair you’re losing.
Hair-pluck test. Also called a trichogram, this involves grasping a larger number of hairs using a surgical clamp, then plucking the hairs out from the scalp. The extracted hairs may be examined to look for club hairs (those with a white bulb at the end) and identify the potential cause of hair loss.
Bacterial or 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.
4.5 average rating
Most forms of hair loss are treatable, either with hair loss medication or making changes to your hair care habits — or both.
Depending on the underlying cause of your hair loss, your healthcare provider may recommend one or more of the following hair loss treatment options.
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 with hair loss medication.
Currently, the FDA (U.S. Food and Drug Administration) has approved two medications to treat male pattern baldness. One is oral finasteride, which works by reducing DHT production. The other is topical minoxidil, whichstimulates hair growth at the scalp level.
Numerous studies have shown that finasteride and minoxidil are effective at preventing hair loss and promoting new hair growth.
In one study, researchers found that the medications are particularly effective when used together, with around 94 percent of men showing improvements after using finasteride and minoxidil for a full year.
We offer finasteride and minoxidil online, with finasteride available following a consultation with a healthcare provider who can determine if a prescription is appropriate. You can also buy finasteride and minoxidil together in our Hair Power Pack.
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 scalp biopsy analysis and results, your healthcare provider may prescribe medication to treat an infection or another scalp issue. They might also suggest certain lifestyle or dietary changes.
Some scalp conditions may require ongoing care and attention. So closely follow your healthcare provider’s guidance.
Sometimes, making small changes to your hair care habits can improve the health of your hair and reduce the severity of hair loss.
This could mean using hair care products formulated to support optimal hair growth, like our hair thickening shampoo and thickening conditioner, or changing your diet to include foods that promote healthy hair growth.
Changes to your lifestyle are unlikely to reverse male pattern baldness on their own. Still, they might help boost 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.
A scalp biopsy is a quick, simple procedure that involves removing a sample of skin from the scalp for testing and analysis.
Here’s what to keep in mind:
Your healthcare provider may suggest a biopsy if you have hair loss without a clear, obvious cause or to get more information about a particular skin condition.
Getting a scalp biopsy typically only takes a few minutes. After the procedure, closely follow your healthcare provider’s instructions to help your skin recover quickly.
Your provider will recommend an appropriate scalp treatment for hair loss option based on the results of your biopsy, your symptoms, your 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.
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.
Dr. Knox Beasley is a board certified dermatologist specializing in hair loss. He completed his undergraduate studies at the United States Military Academy at West Point, NY, and subsequently attended medical school at Tulane University School of Medicine in New Orleans, LA.
Dr. Beasley first began doing telemedicine during his dermatology residency in 2013 with the military, helping to diagnose dermatologic conditions in soldiers all over the world.
Dr. Beasley is board certified by the American Board of Dermatology, and is a Fellow of the American Academy of Dermatology.
Originally from Nashville, TN, Dr. Beasley currently lives in North Carolina and enjoys spending time outdoors (with sunscreen of course) with his wife and two children in his spare time.
Bachelor of Science, Life Sciences. United States Military Academy.
Doctor of Medicine. Tulane University School of Medicine
Dermatology Residency. San Antonio Uniformed Services Health Education Consortium
Board Certified. American Board of Dermatology
Wilson, L. M., Beasley, K. J., Sorrells, T. C., & Johnson, V. V. (2017). Congenital neurocristic cutaneous hamartoma with poliosis: A case report. Journal of cutaneous pathology, 44(11), 974–977. https://onlinelibrary.wiley.com/doi/10.1111/cup.13027
Banta, J., Beasley, K., Kobayashi, T., & Rohena, L. (2016). Encephalocraniocutaneous lipomatosis (Haberland syndrome): A mild case with bilateral cutaneous and ocular involvement. JAAD case reports, 2(2), 150–152. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4867906/
Patterson, A. T., Beasley, K. J., & Kobayashi, T. T. (2016). Fibroelastolytic papulosis: histopathologic confirmation of disease spectrum variants in a single case. Journal of cutaneous pathology, 43(2), 142–147. https://onlinelibrary.wiley.com/doi/10.1111/cup.12569
Beasley, K., Panach, K., & Dominguez, A. R. (2016). Disseminated Candida tropicalis presenting with Ecthyma-Gangrenosum-like Lesions. Dermatology online journal, 22(1), 13030/qt7vg4n68j. https://pubmed.ncbi.nlm.nih.gov/26990472/
Kimes, K., Beasley, K., & Dalton, S. R. (2015). Eruptive milia and comedones during treatment with dovitinib. Dermatology online journal, 21(9), 13030/qt8kw141mb. https://pubmed.ncbi.nlm.nih.gov/26437285/
Miladi, A., Thomas, B. C., Beasley, K., & Meyerle, J. (2015). Angioimmunoblastic t-cell lymphoma presenting as purpura fulminans. Cutis, 95(2), 113–115. https://pubmed.ncbi.nlm.nih.gov/25750965/
Beasley K, Dai JM, Brown P, Lenz B, Hivnor CM. (2013). Ablative Fractional Versus Nonablative Fractional Lasers – Where Are We and How Do We Compare Differing Products?. Curr Dermatol Rep, 2, 135–143. https://idp.springer.com/authorize?response_type=cookie&client_id=springerlink&redirect_uri=https%3A%2F%2Flink.springer.com%2Farticle%2F10.1007%2Fs13671-013-0043-0
Siami P, Beasley K, Woolen S, Zahn J. (2012). A retrospective study evaluating the efficacy and tolerability of intra-abdominal once-yearly histrelin acetate subcutaneous implant in patients with advanced prostate cancer. UroToday Int J, June 5(3), art 26. https://www.urotoday.com/volume-5-2012/vol-5-issue-3/51132-a-retrospective-study-evaluating-the-efficacy-and-tolerability-of-intra-abdominal-once-yearly-histrelin-acetate-subcutaneous-implants-in-patients-with-advanced-prostate-cancer.html
Siami P, Beasley K. (2012). Dutasteride with As-Needed Tamsulosin in Men at Risk of Benign Prostate Hypertrophy Progression. UroToday Int J, Feb 5(1), art 93. https://www.urotoday.com/volume-5-2012/vol-5-issue-1/48691-dutasteride-with-as-needed-tamsulosin-in-men-at-risk-of-benign-prostatic-hypertrophy-progression.html