Hair Pathology

July 2018 in “ Elsevier eBooks ”

Mariya Miteva

TLDR Triple horizontal scalp biopsies are 98% accurate in diagnosing hair loss, better than single biopsies.

The document from 2019 provides a comprehensive analysis of hair loss conditions and their diagnosis through scalp biopsies, emphasizing the superiority of triple horizontal biopsies with a 98% accuracy rate over single biopsies at 79%. It details the histopathological features of various forms of alopecia, such as alopecia areata, chronic telogen effluvium, androgenetic alopecia, alopecia areata incognito, trichotillomania, and different scarring alopecias including lichen planopilaris and frontal fibrosing alopecia. The document also covers other hair disorders like traction alopecia, folliculitis decalvans, dissecting cellulitis, acne keloidalis nuchae, erosive pustular dermatosis, seborrheic dermatitis, scalp psoriasis, lichen simplex chronicus, tinea capitis, syphilitic alopecia, and chemotherapy-induced alopecia, highlighting the importance of clinical correlation and horizontal section assessment for accurate diagnosis. The number of cases in the studies mentioned ranges from 10 to unspecified, and the document underscores the necessity of clinicopathological correlation in diagnosing hair disorders.

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Research cited in this study

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research Permanent Diffuse Alopecia After Hematopoietic Stem Cell Transplantation in Childhood

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Some children who had stem cell transplants developed permanent hair loss, especially when treated with a drug called busulphan.

research Erosive Pustular Dermatosis of the Scalp: Clinical, Trichoscopic, and Histopathologic Features of 20 Cases

53 citations, February 2017 in “Journal of The American Academy of Dermatology”

The conclusion is that high-potency steroids or tacrolimus are effective treatments for erosive pustular dermatosis of the scalp.

research Special Stains and Immunohistochemical Stains in Hair Pathology

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research Lichen Planopilaris in the Androgenetic Alopecia Area: A Pitfall for Hair Transplantation

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Misdiagnosis of LPP in AGA patients can cause hair transplant issues.

research Pathologic Diagnosis of Central Centrifugal Cicatricial Alopecia on Horizontal Sections

29 citations, September 2014 in “American Journal of Dermatopathology”

Horizontal sections of scalp biopsies are good for diagnosing Central Centrifugal Cicatricial Alopecia and help customize treatment.

research Pigmented Casts in Alopecia: A 2014 Study

16 citations, July 2013 in “The American Journal of Dermatopathology”

Pigmented casts are common in several hair loss conditions and can help diagnose specific types of alopecia.

research A Comprehensive Approach to Hair Pathology of Horizontal Sections

12 citations, June 2013 in “The American Journal of Dermatopathology”

A new method using visual aids to diagnose hair diseases was effective after brief training.

research A Detective Look at Hair Biopsies from African-American Patients

40 citations, May 2012 in “British Journal of Dermatology”

Recognizing specific features of African-American hair can help diagnose hair loss conditions.

research Histopathologic Features of Alopecia Areata Incognito: A Review of 46 Cases

34 citations, February 2012 in “Journal of Cutaneous Pathology”

The research found specific signs to diagnose alopecia areata incognito and noted patients generally regrow hair after steroid treatment.

Miniaturized Hairs Maintain Contact With the Arrector Pili Muscle in Alopecia Areata but Not in Androgenetic Alopecia: A Model for Reversible Miniaturization and Potential for Hair Regrowth

research Miniaturized Hairs Maintain Contact With the Arrector Pili Muscle in Alopecia Areata but Not in Androgenetic Alopecia: A Model for Reversible Miniaturization and Potential for Hair Regrowth

22 citations, January 2012 in “International Journal of Trichology”

Miniaturized hairs stay connected to muscle in alopecia areata, allowing possible regrowth, but not in androgenetic alopecia.

research Histopathology of Alopecia Areata, Acute and Chronic: Why Is It Important to the Clinician?

43 citations, May 2011 in “Dermatologic Therapy”

Recognizing the different stages of alopecia areata is crucial for accurate diagnosis and treatment.

research Permanent Alopecia After Systemic Chemotherapy: A Clinicopathological Study of 10 Cases

57 citations, March 2011 in “The American Journal of Dermatopathology”

Chemotherapy can cause permanent, non-reversible hair loss similar to pattern baldness.

Psoriatic Alopecia/Alopecia Areata–Like Reactions Secondary to Anti–Tumor Necrosis Factor-α Therapy: A Novel Cause of Noncicatricial Alopecia

research Psoriatic Alopecia/Alopecia Areata–Like Reactions Secondary to Anti–Tumor Necrosis Factor-α Therapy: A Novel Cause of Noncicatricial Alopecia

72 citations, February 2011 in “The American Journal of Dermatopathology”

Anti-TNF therapy can cause a unique type of hair loss that may get better with topical treatments without stopping the therapy.

research Histopathology of Alopecia: A Clinicopathological Approach to Diagnosis

170 citations, December 2009 in “Histopathology”

The conclusion is that accurate diagnosis of different types of hair loss requires good teamwork between skin doctors and lab experts.

research Follicular Streamers (Stelae) in Scarring and Non-Scarring Alopecia

29 citations, July 2008 in “Journal of Cutaneous Pathology”

Hair root sheaths are more common in non-scarring hair loss and help diagnose the type of hair loss.

research Frontal Fibrosing Alopecia Versus Lichen Planopilaris: A Clinicopathological Study

126 citations, April 2006 in “International Journal of Dermatology”

The conclusion is that FFA and LPP have similar scalp biopsy features, making them hard to distinguish histologically, and FFA may be a specific kind of scarring hair loss.

research The Reliability of Horizontally Sectioned Scalp Biopsies in the Diagnosis of Chronic Diffuse Telogen Hair Loss in Women

137 citations, July 2004 in “Journal of The American Academy of Dermatology”

Horizontally sectioned scalp biopsies are more reliable for diagnosing hair loss in women when three samples are taken instead of one.

research Histological Features of Peripilar Signs Associated with Androgenetic Alopecia

95 citations, January 2004 in “Archives of Dermatological Research”

Peripilar signs can help diagnose androgenetic alopecia and reveal its cause.

research Morphological Approach to Hair Disorders

38 citations, June 2003 in “Journal of Investigative Dermatology Symposium Proceedings”

Accurate clinical, histological, and genetic methods are key for understanding and treating hair disorders.

research Hair Density in African Americans

129 citations, June 1999 in “Archives of Dermatology”

African Americans have less hair density than whites.

research Postmenopausal Frontal Fibrosing Alopecia: A Frontal Variant of Lichen Planopilaris

329 citations, January 1997 in “Journal of the American Academy of Dermatology”

Frontal fibrosing alopecia is a hair loss condition in postmenopausal women, similar to lichen planopilaris, with ineffective treatments.

research Chronic Telogen Effluvium: Increased Scalp Hair Shedding in Middle-Aged Women

234 citations, December 1996 in “Journal of The American Academy of Dermatology”

Middle-aged women with chronic telogen effluvium experience increased hair shedding but usually don't get significantly thinner hair.

research Diagnostic and Predictive Value of Horizontal Sections of Scalp Biopsy Specimens in Male Pattern Androgenetic Alopecia

309 citations, May 1993 in “Journal of The American Academy of Dermatology”

Horizontal scalp biopsy sections effectively diagnose and predict MPAA, with follicular density and inflammation impacting hair regrowth.

research Alopecia Areata Incognita: A Hypothesis

60 citations, January 1987 in “Dermatology”

Alopecia areata may appear differently depending on the individual's type of hair loss and scalp condition.

Related Community Posts Join

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community Calling out diffuse thinners here -- Have you ruled out other factors?

in Treatment 54 upvotes 1 month ago

Diffuse hair loss is often linked to genetics but can also be due to health issues like thyroid problems and low vitamin or iron levels. Treatments include finasteride, minoxidil, and dutasteride, with some seeing improvements after addressing health issues.

community Is there any chance of improvement?

in Minoxidil 7 upvotes 2 years ago

A 19-year-old experiencing severe hair loss since 16 is using a treatment regimen of 5% minoxidil, 0.1% finasteride topical solution, 3% procapil hair serum, and 0.5 mg dutasteride daily. They are concerned about the effectiveness and potential shedding phase, with advice suggesting noticeable changes in 6 to 8 months.

community Diffuse hair loss and scalp biopsies

in Research 692 upvotes 4 months ago

Scalp biopsies are crucial for diagnosing hair loss conditions like Diffuse Unpatterned Alopecia (DUPA) and retrograde hair loss, as treatments like finasteride and dutasteride may not be effective if other conditions are present. Combining PPAR-GAMMA agonists with retinoids could improve treatments for conditions like Lichen Planopilaris.

community C’est terrible - at my wits end

in Female 449 upvotes 1 year ago

A 29-year-old woman is experiencing gradual hair thinning since age 15, suspects Androgenic Alopecia, and has tried 5% minoxidil with little success. She has purchased various hair loss treatments including minoxidil, dutasteride, finasteride, and spironolactone, but is cautious about starting them due to potential interactions with her ADHD medication.

community 2 months progress. Hair is shorter in the first pic, same length in the second and third.

in Progress Pictures 294 upvotes 1 year ago

User reports 2 months progress using daily oral fin 1mg, twice daily topical min 5%, and intermittent dermapen. Others share their experiences, suggesting patience and additional treatments like alternating shampoos, using conditioner, tretinoin, and vitamins.

community How essential is scalp biopsy when dealing with hair loss?

in Treatment 6 upvotes 1 month ago

The user experienced hair loss despite using Fin and Min for 12 years and switched to Dutasteride, RU58841, and Keto scalp serum, but shedding and itch persist. They are considering increasing Dutasteride to 2.5mg and questioning the necessity of a scalp biopsy, with mixed opinions on its usefulness.

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