The Current State of Play in the Histopathologic Assessment of Alopecia: Two for One or One for Two?

February 2013 in “ Journal of Cutaneous Pathology ”

Ameet Tailor, Ruth Asher, Paul Craig, Richard Groves, David A. Fenton, Catherine M. Stefanato

alopecia histopathologic assessment biopsy techniques St. John's protocol HoVert technique Tyler technique transverse sectioning non-scarring alopecia scarring alopecia direct immunofluorescence

TLDR The document concludes that choosing the right biopsy site is crucial for accurate alopecia diagnosis, and combining methods can improve results.

The document from 2013 reviews the effectiveness of various biopsy and sectioning techniques in the histopathologic assessment of alopecia, including the St. John's protocol, HoVert technique, and Tyler technique. It highlights the St. John's protocol's success in increasing diagnostic yield from 52% to 68% in a retrospective analysis of 56 cases and an overall diagnostic yield improvement to 87% in an audit of 413 cases. The review also notes the importance of transverse sectioning in diagnosing non-scarring alopecia, with 88% of such diagnoses relying on this method, and the role of direct immunofluorescence in supporting scarring alopecia diagnoses in 13% of cases. A 'safety-net' protocol is recommended for ambiguous cases, involving two biopsies for different sectioning approaches. The document concludes that while progress has been made in histopathologic evaluation, the choice of biopsy site is critical, and non-invasive techniques are being considered to further improve diagnostic accuracy.

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Research cited in this study

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Vertical vs. Transverse Sections of Scalp Biopsy Specimens: A Pilot Study on the Comparison of the Diagnostic Value of Two Techniques in Alopecia

research Vertical vs. Transverse Sections of Scalp Biopsy Specimens: A Pilot Study on the Comparison of the Diagnostic Value of Two Techniques in Alopecia

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Transverse scalp sections are better for diagnosing non-scarring hair loss, while vertical sections are better for a specific scarring hair loss called lichen planopilaris.

research The HoVert Technique: A Novel Method for the Sectioning of Alopecia Biopsies

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Using both vertical and transverse sections for alopecia biopsies improves diagnosis without extra cost.

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

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