A Comparison of Vertical Versus Transverse Sections in the Evaluation of Alopecia Biopsy Specimens

    Dirk M. Elston, Tammie Ferringer, Scott R. Dalton, Eric P. Fillman, William Tyler
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    TLDR Using both vertical and transverse sections gives a better diagnosis of alopecia than using one method alone.
    In the 2005 study involving 102 archived hair biopsy cases, researchers found that combining vertical and transverse sections was superior for diagnosing alopecia compared to using either method alone. The study revealed that in 76 cases, diagnoses from both section types agreed with the original diagnosis, while in 20 cases, only vertical sections and in 4 cases, only transverse sections were concordant with the original diagnosis. Transverse sections were particularly useful for assessing follicular density and morphology, as well as the anagen-telogen ratio, aiding in the diagnosis of telogen effluvium and pattern alopecia. Vertical sections were more valuable for diseases with significant epidermal changes. The study recommended using both section types when possible and emphasized the importance of step sections and skilled pathologists for accurate diagnosis. However, the study was limited by its focus on scarring alopecia and changes in nomenclature over time.
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