Crown Balding – Causes and Treatments

It is very easy to notice a balding crown, right? Hair loss on the crown is a normal part of aging, but there is much you can do to combat it. A thinning of the hair at the crown is most commonly seen on men’s scalps. As is typical, hair growth on the sides stays steady and is usually combined with a receding hairline in male pattern baldness. 

Here are some basic signs to look out for: 

• Noticeable reduction in hair density in the area, 
• Small bald patches, 
• Hair texture may be finer and softer with split ends, 
• When hair is wet or styled, the scalp may be easily visible. 

The most effective method to treat a balding on crown is hair transplantation. While the average crown area hair transplant costs in the world is around $5,000, but it starts from $1,800 in Turkey. 

If you’re interested in regrowing crown area hair follicles, keep reading to learn causes, what are the opinions of professionals, and specific treatment options.

What is Crown Balding?

The back of the head is called the crown area (vertex), which is located behind the mid-scalp region and at the center of the sides. It is above the occipital bone, but ironically the occipital area is the hairiest side of the head, but the vertex is notorious for spiral hair loss.

Balding on crown commonly occurs on the scalps of men and MTF transsexuals due to androgenetic alopecia (hereditary-patterned baldness). If you notice that you’re suddenly losing hair follicles on your crown faster than your body can replenish them, this could be a symptom of crown hair shedding. 

Crown balding stages can vary in severity from losing a few hair strands a day to more than 150 hair daily.  As a key note, most patients with crown baldness report that they also suffer from a receding hairline. In order to find the best crown hair treatment, understanding the underlying reasons and symptoms of this hair loss pattern can provide a clue to early detection. Below, based on expert commentary, we have outlined the differences in scalp structure and hair follicle growth and shedding according to male and female anatomy.

Exact area of Crown in men and women

Depending on gender, hair growth cycle, hair loss rate and number, hair regrowth rate and treatment options may alter. There are 4 principal areas of the scalp in humans, whether male or female: 

• frontal region, 
• mid-scalp region, 
• vertex transition zone,
• crown. 

The subject area in the article – the crown hair loss – is seen as diffuse thinning in women, and regional hair loss in men. 

Crown area shedding in men: In males, the mid-point of the crown area begins to fall out in a spiral pattern. In the case of pattern hair loss, the bald spot on the crown usually begins to appear within 1-2 years. The balding gradually spreads and extends to the middle scalp region and even to the sidelocks. At about the same time, the frontal part also sheds and the hairline recedes. 

Crown area hair loss in women: Hair patches for females and female balding crown are visible in some women, especially on the front of the head and crown area. Reasons like stress and illness like male pattern alopecia can be causes of bald spots. Nevertheless, most women don’t have a crown- centered balding like men. In women, it is usually seen as a hair thinning on the whole head. Hair is lifeless, frizzy, thinning towards the ends.

How does crown bald area Looks Like?

In a normal crown, there is no sign of hair loss at the crown of the head. The hair is homogeneously distributed all over the head, there is no thinning. However, when one of alopecia types affects the person, the hair on the forehead and then on the crown falls out rapidly. 

Balding at the crown looks like this:

• In the first stages of Norwood or Ludwig scale, initial thinning starts. 
• You begin to find more hair on pillows or in combs. 
• After a while, a round and small bald patch begins to develop in the area. 

When vertex balding on the cranial area, during stage 1 crown balding, the bald spot is small and grows gradually. Then, in the advanced stages of Norwood’s, the round bald patch gradually grows and turns into near-total baldness.

Average age of Crown Balding

Although male androgenetic alopecia affects around 40% of men in their 50s, crown balding starts in the late 20s to early 30s. For women, it may start later, often in their 40s. For men, DHT hormone levels, stress, heredity and age are the main factors for balding crown, but menopause is the key reason for female pattern alopecia patients. 

If you want to hide the crown balding problem in a non-surgical way, you can search for haircut for balding crown men and women. The crown area can be hidden with long hair, or you can make peace with baldness with styles such as buzzcut for men.

Causes of Crown Balding

Crown bald problems affect everybody from their late 10s to 80s. The difference, the underlying causes and the way it progresses. That’s why there’s a rim of hair on the crown:

Male androgenetic alopecia (MAA)

The most well-known form of hair loss in male patients. It affects nearly half of men in their 50s. It spreads to the temples, mid-frontal scalp, and vertex in a very reproducible way. MAA is now recognised as a marker of risk for cardiovascular conditions and arterial stiffness. Plus, heredity accounts for about 80%.

Telogen effluvium

A scalp disorder related to excessive shedding of hair. Drugs, anxiety, and trauma can lead to the development of it. It has two forms: chronic and acute with signs like trichodynia. Doctors can diagnose it with a trichogram, hair wash test, scalp biopsy, and phototrichogram. It usually occurs suddenly following emotionally and physically stressful periods such as unemployment, grieving, illness or divorce. 

Medical therapy

Some medications may have side effects which lead to thinning of hair. The disorders like thyroid disease, lupus, and alopecia areata may result in balding on the crown. Some antidepressants, cancer treatment drugs, antiarrhythmics, anticoagulants, medications for rheumatism, diabetes, and hormone drugs may also have similar side effects.

Lifestyle

You should evaluate lifestyle related hair loss in 3 dimensions. For example, check your daily eating habits. That’s because a lack of nutrients may stop hair growth, and even lose them. Moreover, hormonal imbalance is another aspect. High levels of dihydrotestosterone can easily disrupt the growth cycle because DHT can prolong the telogen phase. 

Traction alopecia

Thinning or balding around the hairline or crown is a common symptom of this balding disorder. Prolonged stress on natural hair follicles is often due to over-styling. If it progresses to advanced stages, your hair may not grow back. Please change your hairstyle if you see such problems. Problematic hairstyles are buns, ponytails, weaves, tight braids, and more. 

Alopecia areata

Alopecia areata usually affects the head and face, although hair can be lost on any area of your body. In this condition, the immune system accidentally attacks the follicles, which causes hair loss. The causes of areata is not clear yet but researchers think that bacteria, medications, and viruses trigger it. 

Trichotillomania

Have you ever thought about pulling out your hair one by one? That’s what people do with this disease. This is called a psychological disorder. For example, pulling out your hair unconsciously while studying. This disorder is classified as OCD and anxiety plays a big part. It is largely manageable with therapies. 

Other scalp conditions

Other scalp conditions like psoriasis, fungal infections, and dandruff can also affect hair growth and lead to bald crown. These are not problems that directly target the crown, but since they affect the entire skin, they lead to a large-scale balding. It is useful to pay attention to hygiene rules and use natural shampoos.

Crown balding treatments alternatives

There are surgical and nonsurgical methods to treat a bald patch crown. When choosing one of these methods, getting help from an expert will help you proceed more scientifically and make a point shot to the problem.

Non Surgical treatments for Crown balding

 

Below are the 4 most effective non-operative methods of stopping hair loss in the crown area:

 

Minoxidil

This is sold under the trade name: Rogaine. Because it’s a vasodilator, Minoxidil can make your blood vessels wider. Therefore, it allows more blood flow through them. Scalps have tiny capillaries, so opening them up helps your follicles get more nutrients and oxygen.  That means they can stay in the growth phase longer and produce denser, thicker, and stronger hair. 

 

The most commonly used form is topical minoxidil because it has less side effects. It can help to stimulate hair growth in a number of different conditions, including:

 

• Male and female pattern baldness
• Chronic telogen effluvium 
• Alopecia areata
• Persistent traction alopecia
• Chemo-induced hair loss

Finasteride

Its well-known brand names are Proscar and Propecia, it can be quite effective in reducing alopecia-related hair loss. Finasteride stops the activity of 5-alpha reductase, which reduces the DHT levels in your blood. That’s why it’s effective on conditions like female and male pattern baldness. 

 

Finasteride can’t be used by premenopausal female patients because it can cause fetal malformations and hormonal imbalances. 

 

Corticosteroids

Topical steroids can be in forms of gels, ointments, and creams. Today, there are a number of real cases that steroid creams reduce alopecia areata-induced hair loss. Except for alopecia areata, people also use it for scalp psoriasis, eczema, and lichen planopilaris. 

 

If the condition is already quite progressed, then intralesional steroid injections can be very effective. Studies show they can help cut down on hair loss in about 60 to 70% of cases of alopecia areata. What’s more, 83% of those with lichen planopilaris who try this therapy can achieve full remission.

 

Dutasteride

Similar to Finasteride, Dutasteride also works the same DHT-reducing principle. It reduces the activity of 5-alpha reductase. So, Dutasteride is better than Finasteride, but how? Finasteride reduces blood DHT by 70%, while Dutasteride cuts this figure by over 98%.

Surgical Treatments for  Crown balding

Here are the 4 most effective operative ways of stopping hair loss and to stimulate hair regrowth in the bald patch crown.

Hair transplants

Hair transplant surgery is the best solution, or even the only prescription, for regrowing lush hair from the balding crown. Follicular unit extraction moves hair from your Hirsute skin to your hairless crown. After a few months of adaptation, thick hair begins to grow there as well. Thus, your own hair follicles are replaced in your body and you get natural hair. And you heard it right: the success rate exceeds 97%. 

Scalp reduction surgery

Forehead reduction removes diseased skin that is affected by any type of alopecia. So, the goal for surgeons is to reduce the overall bald area on your head. The good news is that the healthy part of your scalp is stretched and relocated, which makes the bald area smaller. 

Microneedling with PRP

Platelet-rich plasma is a way of helping your body to regenerate cells more quickly by re-injecting plasma made from your own blood. This technique isn’t strictly surgical, but it involves using microneedles to open up tiny wounds in the scalp. Then, it injects platelet-rich plasma (PRP) to encourage hair growth.

Micropigmentation

A cosmetic tattoo procedure that uses tiny dots on the scalp to give the illusion of natural hair follicles, which makes the scalp look thicker and denser. In general, clinics use iron oxide pigmentation injected just under the skin to semi-permanently improve or make certain features look better.

FAQs About Crown Balding Causes and Treatments

Reference List

1. Cranwell W, Sinclair R. Male Androgenetic Alopecia. Nih.gov. Published February 29, 2016. https://www.ncbi.nlm.nih.gov/books/NBK278957/ 
2. ‌Asghar F, Shamim N, Farooque U, Sheikh H, Aqeel R. Telogen Effluvium: A Review of the Literature. Cureus. 2020;12(5). doi:https://doi.org/10.7759/cureus.8320 
3. Olsen EA, Weiner MS, Delong ER, Pinnell SR. Topical minoxidil in early male pattern baldness. Journal of the American Academy of Dermatology. 1985;13(2):185-192. doi:https://doi.org/10.1016/s0190-9622(85)70157-0 
4. ‌Kumaresan M. Intralesional Steroids for Alopecia Areata. International Journal of Trichology. 2010;2(1):63-65. doi:https://doi.org/10.4103/0974-7753.66920 
5. ‌Gubelin Harcha W, Barboza Martínez J, Tsai TF, et al. A randomized, active- and placebo-controlled study of the efficacy and safety of different doses of dutasteride versus placebo and finasteride in the treatment of male subjects with androgenetic alopecia. J Am Acad Dermatol. 2014;70(3):489-498.e3. doi:10.1016/j.jaad.2013.10.049 

Article Review By: Dr. Jyothi Shenoy V
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MBBS, MD – Obstetrics & Gynaecology, MRCOG(UK)
23 Years Experience Overall