Scalp Biopsy for Hair Loss: What You Should Know

Hair loss is a common problem for many men and women all around the world, irrespective of their backgrounds and ages.

Hair loss can occur from many underlying causes and is often attributed to issues such as pattern baldness, chemical treatments, excessive grooming, chronic stress, autoimmune conditions, and poor nutritional profile.

However, most often, you don’t know the exact reason for your hair loss. This is when you take your doctor’s help.

The bad news is, sometimes, even a specialist is unable to figure out the cause of your hair loss because your routine tests and blood profile come out to be normal.

This is when a scalp biopsy comes in handy!

When hair starts thinning and falling without a clear cause, your healthcare provider may ask you to get a scalp biopsy to learn about the very issue that’s causing your hair to shed and also to suggest the most effective treatment for the same. (1)

While the thought of a scalp biopsy may seem unsettling and scary for many, the procedure is generally quick and involves minimal discomfort.

This article will present what scalp biopsy is and how accurately it diagnoses hair loss.

A scalp biopsy is a pretty simple medical procedure used to diagnose various scalp conditions. It is invasive as it involves taking a small skin sample from your scalp for testing. (2)

Healthcare specialists use different techniques, such as punch biopsies (using a circular tool) or shave biopsies (shaving a small section of skin) to look into the cause of your hair loss. These small samples, smaller than a pencil eraser, are sent to a specialized skin pathologist for analysis. (3)

The biopsy allows healthcare providers to successfully diagnose scalp troubles, including androgenetic alopecia, by examining the hair follicles for damage or counting them.

It can also reveal signs of hair problems related to autoimmune conditions or scalp disorders.

A scalp biopsy can tell your doctor a lot about your hair and scalp health.

First, it allows for a closer examination of the hair follicles, identifying any damage that might be causing the hair loss. It provides a count of your hair follicles and hair.

Second, it helps identify the presence of scalp infections or skin problems that may affect the scalp and thus can be the underlying reasons for hair loss. (3)

Additionally, it is good for detecting inflammatory responses, which are sometimes to be blamed for hair loss. Addressing them can help slow or discourage hair shedding. (4)(3)

Lastly, a scalp biopsy provides information about the current status of hair loss and the potential for hair recovery and regrowth.

In certain cases, it’s also useful when unusual moles or skin growths are present on the scalp to determine if medical attention is required or not.

Research has shown that scalp biopsies are crucial for accurately diagnosing the cause of hair loss.

Different sections can be examined to diagnose different hair loss factors.

Horizontal section biopsies are more useful in noncicatricial alopecia cases, while vertical section biopsies are beneficial for cicatricial alopecia. (5)

Horizontal sections help determine follicular counts, density, and ratio, making them essential for conditions such as telogen effluvium and androgenetic alopecia. However, they may be less useful in other cases, such as discoid lupus erythematosus.

Some newer techniques, such as the “HoVert technique,” show promise in simplifying diagnostics, but further research is needed to confirm their effectiveness. (5)

In sum, scalp biopsy can be a pretty self-sufficient and promising way of diagnosing hair loss problems.

A scalp biopsy can be done in many cases to confirm the diagnosis of hair issues. It is helpful in differentiating between different causes of hair loss.

Some popular indications of a scalp biopsy include: (3)

  • Differentiating between female-pattern hair loss and chronic telogen effluvium: Female-pattern hair loss is gradual, whereas chronic telogen effluvium causes excessive shedding for months.
  • Differentiating between chronic diffuse alopecia areata and male-pattern hair loss: Chronic alopecia areata is long term and affects various areas, whereas male-pattern hair loss leads to receding hairlines or bald crowns in men.
  • Lymphocytic scarring alopecias: Conditions resulting from inflammation and scarring of the hair follicles
  • Trichotillomania: Compulsive hair pulling leading to hair loss
  • Unusual scalp lumps or bumps
  • Check-up for hair transplant

A scalp biopsy is a very simple and painless procedure that is nothing to be scared of.

For a scalp biopsy to begin, your scalp should be freshly washed and cleaned but without the use of any hair care products so that the doctor can have access to real skin samples.

After this, your job is pretty much done. Everything will now be done by the professional, who will start by applying a local anesthetic to the scalp so that you feel no discomfort or pain. (4)

Once the anesthesia is on, the doctor will take a sample of your scalp and also some hair follicles using common equipment such as a scalpel or punch tool. The sample taken is very small and not even the size of a pea.

After the sample has been taken, the doctor will cover the area of the scalp from where the sample was taken using a bandage and will hand you a list of instructions for post-biopsy care.

The doctor will send your sample to the lab for analysis. Based on the lab results and reports, they will draw conclusions regarding the factors that contribute to your hair loss. (6)

There are many available techniques for hair loss diagnosis other than scalp biopsy, and they include: (2)

  • Questionnaire: Answer questions about your hair and any issues you’ve noticed.
  • Daily Hair Counts: Count how many hairs you lose in a day.
  • Standardized Wash Test: See how much hair falls out when washing.
  • 60-Second Hair Count: Count the hairs that fall out in a minute.
  • Global Photographs: Pictures of your scalp for analysis.
  • Dermoscopy: Examine the scalp and hair with a special device.
  • Hair Weight: Weigh hair samples to measure loss.
  • Contrasting Felt Examination: Assess hair loss using a contrasting felt pad.
  • Phototrichogram: Use photos to study hair growth and loss.
  • TrichoScan: Analyze hair with a specialized device.
  • Polarizing and Surface Electron Microscopy: Use advanced microscopy to study hair.
  • Trichogram and Unit Area Trichogram: Assess hair loss through specific tests.

Healthcare professionals use an anesthetic to make it as painless as possible.

Scalp biopsies are rarely ever associated with side effects.

You’ll receive your results based on how fast your lab provider is. It can be within a few days to a couple of weeks.

You can only get a scalp biopsy if your doctor thinks it’s necessary. 

Scalp biopsies help figure out why your hair is falling out when other tests can’t.

During the procedure, your doctor takes a tiny piece of skin and some hair follicles from your scalp. It’s not a painful process, as they use an anesthetic.

This sample tells them if your hair loss is due to damaged follicles, infections, or inflammation. It also shows the potential for hair to grow back.

Research supports the effectiveness of scalp biopsies in diagnosing hair loss.