Histopathology of Alopecia: A Clinicopathological Approach to Diagnosis

December 2009 in “ Histopathology ”

Catherine M. Stefanato

Studysummary This review discusses the histopathological diagnosis of scarring and non-scarring alopecias, emphasizing the importance of adequate tissue sampling and clinical information; it reports no new empirical results.

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

The document reviewed the histopathological diagnosis of scarring and non-scarring alopecias, highlighting the importance of proper tissue sampling, laboratory processing, and clinical information. It detailed the histopathological features of various alopecias, including lymphocytic scarring alopecias like discoid lupus erythematosus and lichen planopilaris, neutrophilic scarring alopecias such as folliculitis decalvans, and non-scarring alopecias like androgenic alopecia, telogen effluvium, and alopecia areata. The document recommended a clinicopathological approach involving both transverse and vertical sectioning of biopsy specimens for improved diagnosis and outlined specific protocols for processing these biopsies. It also described the clinical presentations of these conditions, such as the pattern of hair loss in frontal fibrosing alopecia and central centrifugal cicatricial alopecia, and the histological distinctions between chronic telogen effluvium and female pattern hair loss, as well as the autoimmune nature of alopecia areata. The document emphasized the need for strong communication between dermatologists and pathologists for accurate diagnosis of alopecia.

View this study on onlinelibrary.wiley.com →

Discuss this study in the Community →

Research cited in this study

46 / 46 results

research Central Centrifugal Cicatricial Alopecia: Past, Present, and Future

75 citations , March 2009 in “Journal of The American Academy of Dermatology”

This review discusses the evolution and ongoing debate about the causes of central centrifugal cicatricial alopecia in African American women, without presenting new clinical findings.

research Cicatricial Marginal Alopecia: Is It All Traction?

27 citations , September 2008 in “British Journal of Dermatology”

This study describes patients with moderate to severe scarring alopecia of the scalp margin and suggests that traction is not the sole cause for this condition, as half of the patients had no history of harsh hairstyling practices.

research Determinants of Marginal Traction Alopecia in African Girls and Women

94 citations , September 2008 in “Journal of the American Academy of Dermatology”

This study found that traction alopecia risk was higher in adults than children and increased further when traction was combined with chemically relaxed hair.

research Dermal Mucin in Alopecia Areata: Tell-Tale Sign or Incidental Finding?

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

This study reports that marked, deep dermal mucin deposition in a patient with alopecia areata may indicate underlying systemic lupus erythematosus, as this feature was not prevalent in other alopecia areata cases.

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

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

This study found that follicular streamers are mostly present in non-scarring alopecia cases, and tracking their location can improve diagnosis accuracy.

research Cicatricial Alopecia: Classification and Histopathology

74 citations , July 2008 in “Dermatologic therapy”

This review discusses histopathologic findings in diagnosing primary cicatricial alopecias and emphasizes the importance of correlating histology with clinical presentation for accurate diagnosis; it reports no new results.

research Lichen Planopilaris: Chronic Scarring Alopecia with Autoimmune Component

90 citations , July 2008 in “Dermatologic therapy”

This article reviews lichen planopilaris, a chronic scarring alopecia, and explores recent treatment developments, but it reports no new clinical results.

research Secondary Cicatricial and Other Permanent Alopecias

20 citations , July 2008 in “Dermatologic Therapy”

This review discusses various nonfollicular scalp conditions causing secondary scarring or permanent alopecia and highlights the importance of specific diagnoses and treatments but reports no new results.

research Folliculitis Decalvans: A Rare Inflammatory Scalp Disorder

112 citations , July 2008 in “Dermatologic Therapy”

This review outlines the diagnosis and management of folliculitis decalvans, an inflammatory scalp disorder, and highlights Staphylococcus aureus and immune response deficiencies as key factors in its development.

research Pseudopelade of Brocq: A Review of a Rare Hair Disorder Leading to Cicatricial Alopecia

39 citations , July 2008 in “Dermatologic Therapy”

This review provides a practical approach to diagnosing pseudopelade of Brocq and updates on treatment options but reports no new clinical results.

research Central Centrifugal Cicatricial Alopecia

72 citations , July 2008 in “Dermatologic Therapy”

This article reviews central centrifugal cicatricial alopecia in African-descent females, discussing possible causes, associated styling habits, and potential treatments, but reports no new clinical findings; the authors call for further research.

research A Histologic Review of 27 Patients with Lichen Planopilaris

76 citations , June 2008 in “Journal of the American Academy of Dermatology”

In this study, key histologic features such as mucinous perifollicular fibroplasia were identified to aid in the diagnosis of lichen planopilaris.

research Dermal Fibrosis in Male Pattern Hair Loss: A Suggestive Implication of Mast Cells

19 citations , February 2008 in “Archives of Dermatological Research”

This study observed that mast cells and increased collagen and elastic fibers in the scalp may contribute to male pattern hair loss, but additional research is needed for further understanding.

research Investigation of the Hair Follicle Inner Root Sheath in Scarring and Non-Scarring Alopecia

28 citations , June 2007 in “Journal of Cutaneous Pathology”

This study found that premature desquamation of the inner root sheath is a non-specific histologic feature in scarring alopecia and cannot be used alone to define central centrifugal cicatricial alopecia.

research Follicular Miniaturization in Female Pattern Hair Loss: Clinicopathological Correlations

100 citations , June 2006 in “British Journal of Dermatology”

This study found that as hair loss severity increased in women with female pattern hair loss, the number of vellus follicles also rose, indicating miniaturization of terminal hair follicles.

research Histopathologic Evaluation of Alopecias

90 citations , June 2006 in “The American Journal of Dermatopathology”

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.

research The Histopathology of Noncicatricial Alopecia

43 citations , March 2006 in “Seminars in Cutaneous Medicine and Surgery”

This review examines the histopathologic features of four common types of noncicatricial alopecia and reports no new clinical results.

research Alopecia Areata: A Tissue-Specific Autoimmune Disease of the Hair Follicle

185 citations , August 2005 in “Autoimmunity Reviews”

This review discusses alopecia areata as a model for studying tissue-directed autoimmune diseases and reports no new clinical findings.

research Frontal Fibrosing Alopecia: A Survey in 16 Patients

123 citations , August 2005 in “Journal of the European Academy of Dermatology and Venereology”

In this study, the researchers observed that treatment with intralesional and topical corticosteroids, finasteride, and minoxidil may stop the progression of frontal fibrosing alopecia in postmenopausal and premenopausal women.

research Vertical vs. Transverse Sections in Alopecia Biopsy Diagnosis

33 citations , August 2005 in “The American Journal of Dermatopathology”

This article provides departmental contact information for Dr. Dirk M. Elston at the Geisinger Medical Center and reports no research findings.

research Transverse Sections for Diagnosis of Alopecia?

24 citations , August 2005 in “The American Journal of Dermatopathology”

This article critically assesses literature favoring horizontal over vertical sections for diagnosing scalp diseases and concludes that a qualitative, vertical approach improves diagnostic precision for alopecias.

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

56 citations , July 2005 in “Journal of The American Academy of Dermatology”

This study found that vertical sections of alopecia biopsy specimens had a higher concordance rate with the original combined diagnosis compared to transverse sections alone, although both methods have their pros and cons.

research Chronic Telogen Effluvium: A Study of 5 Patients Over 7 Years

54 citations , January 2005 in “Journal of The American Academy of Dermatology”

In this study, four women with chronic telogen effluvium experienced fluctuating hair shedding without visible reduction in hair density or follicular miniaturization over at least 7 years.

research Frontal Fibrosing Alopecia in Postmenopausal Women

179 citations , December 2004 in “Journal of The American Academy of Dermatology”

This study observed that frontal fibrosing alopecia in postmenopausal women involves selective follicular inflammation, and finasteride treatment may slow disease progression, suggesting a potential androgen-related component.

research Fibrosing Alopecia in a Pattern Distribution Localized on Androgenetic Alopecia Areas and Unaffected Scalp

9 citations , November 2004 in “SKINmed Dermatology for the Clinician”

This case report describes a 54-year-old man diagnosed with fibrosing alopecia in a pattern distribution, presenting with follicular inflammatory lesions and scleroatrophy on the scalp.

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”

This study observed that triple horizontal scalp biopsies provided a more accurate diagnosis of female pattern hair loss in women than a single horizontal biopsy, especially for those with advanced hair loss.

research Chronic Telogen Effluvium or Early Androgenetic Alopecia?

12 citations , March 2004 in “International Journal of Dermatology”

This case report describes a 16-year-old girl initially diagnosed with chronic telogen effluvium, later reassessed with Ludwig Stage 1 androgenetic alopecia, for which she began spironolactone treatment.

research Autoimmunity: Alopecia Areata

143 citations , January 2004 in “Journal of Investigative Dermatology Symposium Proceedings”

This review discusses the autoimmune nature of alopecia areata, potential therapeutic targets, and highlights the need for further studies on immunomodulatory treatments and genetic factors, but it reports no new clinical results.

research Primary Cicatricial Alopecias: Clinicopathology of 112 Cases

254 citations , December 2003 in “Journal of the American Academy of Dermatology”

This study reviewed the epidemiology and treatment of inflammatory cicatricial alopecias and highlighted the importance of scalp biopsies for accurate diagnosis in a mixed ethnic population at a university hair clinic.

research Female Pattern Hair Loss

86 citations , July 2002 in “Clinical and Experimental Dermatology”

This review discusses female pattern hair loss, emphasizing its complex causes and the limited treatment options available, and reports no new clinical results.

research Frontal Fibrosing Alopecia Associated with Cutaneous Lichen Planus in a Premenopausal Woman

89 citations , February 2002 in “Australasian journal of dermatology”

This case report describes the first known instance of fibrosing alopecia associated with cutaneous lichen planus, suggesting fibrosing alopecia may be a variant of lichen planopilaris.

research The Histopathology of Alopecia Areata in Vertical and Horizontal Sections

19 citations , December 2001 in “Dermatologic Therapy”

This study reports that horizontal sections of scalp biopsies improve the diagnosis of alopecia areata, especially when characteristic inflammatory infiltrates are missing.

research Female Pattern Hair Loss

226 citations , September 2001 in “Journal of The American Academy of Dermatology”

Hair loss in women is genetic, diagnosed by examination and biopsy, and treated with minoxidil, finasteride, or transplantation.

research Elastic Tissue in Scars and Alopecia

80 citations , March 2000 in “Journal of cutaneous pathology”

This study found that the Verhoeff-Van Gieson stain effectively distinguishes scarred from non-scarred dermis and aids in classifying types of permanent alopecia based on elastic tissue patterns.

research Fibrosing Alopecia in a Pattern Distribution

158 citations , February 2000 in “Archives of dermatology”

This study reports that some patients with androgenetic alopecia may also exhibit clinical and histological features of inflammation and fibrosis, similar to those found in lichen planopilaris.

research Eosinophils in Fibrous Tracts and Near Hair Bulbs: A Helpful Diagnostic Feature of Alopecia Areata

64 citations , July 1997 in “Journal of The American Academy of Dermatology”

This study found that eosinophils are a useful diagnostic feature for alopecia areata, especially when the typical "swarm of bees" lymphoid infiltrate is absent, helping differentiate it from trichotillomania.

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

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

This study reports that progressive frontal fibrosing alopecia, a distinct and gradually stabilizing form of lichen planopilaris affecting elderly women and often involving eyebrow hair loss, lacks effective 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”

The authors concluded that chronic telogen effluvium in middle-aged women presents distinct clinical and histological features that differ from androgenetic alopecia and acute telogen effluvium.

research Histopathology of Non-Scarring Alopecia

122 citations , April 1995 in “Journal of Cutaneous Pathology”

The document describes how to tell different types of non-scarring hair loss apart by looking at hair and scalp tissue under a microscope.

research Vertical and Transverse Sections of Alopecia Biopsy Specimens: Combining the Two to Maximize Diagnostic Yield

71 citations , March 1995 in “Journal of The American Academy of Dermatology”

This study concluded that combining vertical and transverse sections of scalp biopsy specimens improves diagnostic yield for certain hair disorders without increasing costs.

research Androgenetic Alopecia: An Autosomal Dominant Disorder

80 citations , January 1995 in “The American Journal of Medicine”

Hair loss in androgenetic alopecia is caused by genetic factors and androgen excess, and can be treated with combined therapies.

research Postmenopausal Frontal Fibrosing Alopecia

325 citations , June 1994 in “Archives of Dermatology”

This study observed that progressive frontal recession in postmenopausal women may exhibit features of fibrosing alopecia, suggesting a distinct reaction pattern from typical lichen planopilaris.

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”

This study concluded that horizontal sections of scalp biopsy specimens provide more diagnostic information for male pattern androgenetic alopecia than vertical sections and can predict hair regrowth potential following topical minoxidil therapy.

research Classification of the Types of Androgenetic Alopecia (Common Baldness) Occurring in the Female Sex

666 citations , September 1977 in “British Journal of Dermatology”

This article presents a classification system for stages of female-pattern androgenetic alopecia to aid early diagnosis and mentions existing systems for rare male-pattern cases, but reports no new clinical results.

research Traumatic Alopecia in Trichotillomania: A Pathogenic Interpretation of Histologic Lesions in the Pilosebaceous Unit

37 citations , April 1977 in “Journal of Cutaneous Pathology”

This study found that specific histologic features in skin biopsies can help support a diagnosis of traumatic alopecia (trichotillomania), but not all markers are distinct to the condition.

research Hot Comb Alopecia

107 citations , September 1968 in “Archives of Dermatology”

In this study, researchers identified a form of irreversible scalp alopecia in Black women using hot combs, characterized by incomplete hair loss primarily on the crown and follicular scarring.