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If he has no hair, then he does not have to do anything; he does not have to pass the razor over his head, and he may exit ihraam without shaving his head.
But if he has some hair, no matter how little, then he should pass the razor over it and shave it, and by doing so he will exit ihraam.
Shaykh Ibn ‘Uthaymeen (may Allah have mercy on him) was asked about the bald man who has no hair at all: what should he do when exiting ihraam? Does he have to pass the razor over his head?
He replied: He does not have to do anything; he does not have to pass the razor over his head. Some of the scholars said that he should pass the razor over his head, but this is not correct. End quote.
Majmoo‘ Fataawa Ibn ‘Uthaymeen (23/159)