A woman being examined by a dermatologist prior to a scalp biopsy

Scalp Biopsies: Everything You Need to Know To Understand Your Scalp

There are many procedures that you as a hair loss sufferer will undergo as part of the diagnosis and treatment process. A common one is scalp biopsies, and they can be a crucial tool in proper diagnosis.

In this comprehensive guide, I’ll provide you with a deeper look at scalp biopsies. This will include what they’re used for, how they’re performed, and what you can expect from the procedure.

In addition, I’ll guide you through the procedure – from initial consult to receiving the results.

What Is a Scalp Biopsy?

Just as the name suggests, a scalp biopsy is a procedure that involves the removal of a small portion of scalp from the patient’s head.

Why Is It Performed?

Biopsies are performed for various reasons, though the most common is for use as a diagnostic tool. In the case of scalp biopsies, they are performed to diagnose lesions, unusual cosmetic marks, or hair loss.

How Is It Done?

A scalp biopsy is a very simple procedure that typically utilizes a punch biopsy tool to extract an area of skin and hair follicles from the scalp.

The area to be biopsied is first cleaned and disinfected, and the area where the biopsy will be taken is marked. Any hair present is trimmed, and the area is then anesthetized.

A punch biopsy being performed
Source.

Once the numbing agent has taken effect, the punch tool is placed on top of the outlined area. Using a needle, the excised skin is then removed.

The small opening is then closed (it’s done differently depending on the doctor).

If a stitch was used, a follow-up appointment will be done in 10 – 14 days to remove the suture.

Risks Associated With a Skin Biopsy

As with any medical procedure, there are risks involved. However, these are very minor as far as medical risks go.

The most common risks associated with a biopsy can be broken into preoperative, intraoperative, and postoperative.

Preoperative Risks

The most common preoperative risk is related to anesthetic.

In rare cases, anaphylaxis can occur. This can be prevented by sharing past medical history with your doctor, and performing a patch test if a true sensitivity to the anesthesia is suspected.

A vasovagal attack can also occur, though this is harmless and can be prevented by sharing any history of syncopal attacks.

Intraoperative Risks

The procedure itself poses the most risks, but even these are minor and can be properly handled by your physician.

Pain and discomfort are the two most common complications, and bleeding is also likely to occur. In certain cases, your physician may have difficulty closing the site.

You may also experience temporary numbness or weakness as a result of the nearby nerve structures. As they structures are minimal and superficial in the scalp, however, permanent damage is rare.

Postoperative Risks

Following the procedure, you may experience pain, bleeding, swelling, and tenderness. Your doctor will help you to get these under control and give you instructions for further treatment.

Biopsy hyperpigmentation
An area of hyperpigmentation present following a 3mm biopsy. Source.

The most common side effect is infection. In a 2007 study, 22% of patients (22 out of 100) showed signs of postoperative infection. This can be easily treated with an antibiotic.

Scarring and hyperpigmentation can also occur, with scarring being a very real risk during scalp biopsies.

As a result, no new hair growth will occur in the area. However, you can speak with your doctor about taking the biopsy from an easily hidden area (if possible).

Preparing for a Biopsy

Before you go in for the actual procedure, there will be a few things that need to get done first. Let’s take a look.

Consult With Your Doctor

Before the biopsy takes place, it’s important that you have a thorough consult with the physician who will be performing the procedure. This will likely be a dermatologist.

During this consult, you’ll be asked many questions about your health (past and present), current medications, and lifestyle.

You want to disclose everything even if it doesn’t seem relevant. There are some illnesses (such as clotting disorders) and medications (such as blood thinners and immunosuppressants) that can make the procedure more dangerous.

In addition, certain lifestyle choices (such as smoking and excessive drinking) can put you at a higher risk of side effects (including bleeding and slow healing).

Blood Draw

Before the biopsy moves forward, it’s common for the physician to order a blood test. This is to check for any potential issues and rule out any common causes of the issue you’re dealing with.

Depending on the tests ordered, it may take a few weeks for results to arrive. This means the blood draw will be done 2-4 weeks before your scheduled biopsy.

What to Expect During the Procedure

As you prepare to undergo your biopsy, you may be wondering how it will all play out. Here’s a rundown of things to expect during the procedure.

1. The Area May Be Shaved

Depending on the area, as well as the purpose of the biopsy, the area where the specimen will be taken may be completely shaved or just trimmed.

This enables the doctor to a better look at the area, and it can make specimen examination easier.

2. The Area Will Be Cleaned

Once the surrounding hairs have been handled, your doctor will clean the area with alcohol, iodine, or a similar solution.

While skin biopsies carry with them a very small risk of infection, the majority of doctors will perform this preventative task. It only takes a few seconds, and it can help prevent future issues.

3. A Local Anesthetic Will Be Used

To ease the pain and discomfort felt by the patient, a local anesthetic will be injected into the area where the biopsy will be taken. The anesthetic will wear off in a few hours’ time, and all typically does is numb the surrounding area.

As it’s local, however, you will be able to drive yourself home and will not be in anyway incapacitated. You can even return to work or school with no issues.

4. You May Receive Sutures

Depending on the biopsy taken, you may require stitches or adhesive to close the small wound.

In the cause of punch biopsies, a single stitch is common. However, some doctors prefer to leave the wound open, while others prefer to pack it with cloth dressing.

What to Expect After the Procedure

Once the procedure has been performed, you can return to work, school, or your other usual daily routine.

As the anesthetic wears off, you may experience a bit of discomfort or pain. In addition, bleeding may occur following the procedure, though it should be minimal and your doctor will give you instructions on stopping it.

You should receive a call from your doctor with results – the length of time depends on the reason for the biopsy – at which time you would return for a consult.

In terms of healing, the entire process should only take 1 – 2 weeks. However, a punch biopsy will leave a small scar and no hair will be able to grow from this area.

Can a Scalp Biopsy Diagnose Hair Loss?

One of the main reasons a patient undergoes a biopsy is to diagnose an unknown problem. In the case of hair loss, the same can be done to find a cause.

How Is the Diagnosis Made?

Once the biopsy has been removed, it is then either stored in a chemical solution (“fixed”) or snap frozen using liquid nitrogen. In the cause of hair loss diagnosis, the practice of “fixing” the specimen is most common.

Once the specimen has had time to settle, it is then sliced using a specialized tool. These slices are typically very small – 4 to 6 micrometers in width – and each is placed on its own slide for further examination.

Using a combination of alcohols, oils, and dyes, each slice is then examined under a microscope. The physician or lab technician will then look for specific markers – the exact marker will depend on the type of alopecia suspected – and take note of any irregularities.

Once the tissue samples have been properly examined, they are then preserved and store, destroyed, or sent out for further testing.

One thing that the doctor or pathologist will look for is what percentage of hairs are in telogen phase. Only 10% to 20% of hairs should be in this stage at any given time, so more than that can alert the doctor to an issue.

A magnified skin biopsy specimen
Copyright © 2011 Michael Bonert. License.

Another thing that will be looked at is the state and health of the hair follicle. Is miniaturization occurring, or are there are structural abnormalities to be seen in any samples?

These can be signs of thinning and recession caused by Androgenetic Alopecia (AGA), or other issues that disrupt the growth cycle.

(Learn more about hair miniaturization and the role it plays in hair loss here.)

Is A Biopsy Worth It?

As the results of a scalp biopsy can pinpoint the cause of your hair loss, it’s certainly worth it in the long run.

To properly treat your alopecia – whether through natural means or not – it’s important to know and understand the cause. Only with this information can you target the issue and treat it at the source.

Is it possible to treat hair loss without a biopsy? Of course! Though, it will require more trial and error on your part. This can mean a delay in proper treatment, which may not be good for your hair and scalp over time.

I’ve Got the Results – Now What?

You’ve received the results from your doctor. So, what are the next steps?

With an official diagnosis – as well as knowledge of the exact cause – you can now move forward with treatment plans.

The exact treatment options will depend on the type of hair loss. For example, your doctor may recommend Rogaine or Propecia for a diagnosis of AGA, while a course of corticosteroids will likely be prescribed for Alopecia Areata (AA).

Of course, you can also feel free to explore natural methods and treatment options (which I highly recommend).

Conclusion

For many hair loss sufferers, a scalp biopsy is one procedure performed to give them a better idea of the cause. Of course, it’s not necessary, but it can help.

Overall, I think biopsies can be beneficial when the cause of alopecia is not obvious. Many forms of hair fall – including AGA and AA – have clear patterns and signs. In such cases, a biopsy may cause more harm than good.

But no matter where you are on your journey, I do recommend you figure out the cause of your hair loss even if it does mean getting a biopsy done.

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