Histopathologic Evaluation of Alopecias

June 2006 in “ The American Journal of Dermatopathology ”

Klaus Sellheyer, Wilma F. Bergfeld

alopecia histopathologic evaluation hair growth cycle anagen phase scarring alopecia nonscarring alopecia elastic tissue stains androgenetic alopecia follicle miniaturization anagen:telogen ratio perifollicular inflammation telogen effluvium chronic telogen effluvium alopecia areata trichotillomania traction alopecia primary scarring alopecias stem cell failure sebaceous gland damage outer root sheath destruction DLE lichen planopilaris pseudopelade of Brocq special stains immunofluorescence mixed inflammatory primary scarring alopecias folliculitis keloidalis hair loss hair cycle scarring hair loss nonscarring hair loss elastic stains male pattern baldness hair follicle shrinkage hair growth phase ratio hair follicle inflammation temporary hair shedding chronic hair shedding autoimmune hair loss hair pulling disorder traction hair loss scarring hair loss types stem cell damage sebaceous gland injury outer hair sheath damage discoid lupus erythematosus lichen planus of the hair Brocq's pseudopelade special hair stains immunofluorescence staining mixed inflammatory scarring hair loss keloid folliculitis

Studysummary This review outlines the classification, histopathologic presentation, and pathogenetic concepts of scarring and nonscarring alopecias, reporting no new clinical results and emphasizing the need for clinicopathologic correlation.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

The document from 2006 provides a comprehensive review of the histopathologic evaluation of alopecias, emphasizing the importance of clinicopathologic correlation for accurate diagnosis due to the overlap in histopathologic features among different types of alopecia. It describes the hair growth cycle, with anagen being the most affected phase by alopecia, and discusses the ambiguity in classifying alopecias as scarring or nonscarring, noting the prognostic importance of identifying true scarring. Elastic tissue stains are highlighted as useful in differentiating these alopecias. Androgenetic alopecia, the most common form of hair loss, is characterized by follicle miniaturization and a decreased anagen:telogen ratio, with the significance of perifollicular inflammation remaining unclear. The document also covers telogen effluvium, chronic telogen effluvium, alopecia areata, trichotillomania, and traction alopecia, detailing their histopathologic features and the necessity of histopathology for differential diagnosis. Additionally, it discusses the classification and pathogenesis of primary scarring alopecias, including stem cell failure, sebaceous gland damage, and destruction of the outer root sheath. The document further examines the differentiation between DLE, lichen planopilaris, and classic pseudopelade of Brocq, highlighting the role of special stains and immunofluorescence. Lastly, it touches on mixed inflammatory primary scarring alopecias, such as folliculitis keloidalis, and the importance of histopathologic differential diagnosis.

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