A Brief Review of Scalp Biopsy and Its Interpretation

July 2025 in “ Indian Dermatology Online Journal ”

Shreya K Gowda, Biswanath Behera, Madhusmita Sethy, Pavithra Ayyanar

scalp biopsy histopathological evaluation cicatricial alopecia non-cicatricial alopecia hair structures biopsy techniques horizontal sectioning vertical sectioning scarring alopecia trichoscopy histological features clinicopathological correlation

Studysummary This source outlines the crucial steps and techniques for conducting scalp biopsies to diagnose cicatricial and non-cicatricial alopecias, emphasizing the importance of proper biopsy site selection, technique, and specimen processing to accurately interpret histopathology and understand related hair follicle disorders.

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

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research Alopecias in Lupus Erythematosus

39 citations , October 2018 in “Lupus Science & Medicine”

This article discusses various patterns of hair loss associated with lupus erythematosus, emphasizing the importance of identifying the specific type to aid in classifying systemic lupus erythematosus.

research Primary Scalp Alopecia: New Histopathological Tools, New Concepts, and a Practical Guide to Diagnosis

14 citations , September 2016 in “Journal of Cutaneous Pathology”

This review discusses the classification and diagnosis of primary scalp alopecia, focusing on scarring and non-scarring types, and reports no new clinical results; it emphasizes simplified diagnostic pathways and tissue processing techniques.

research Pigmented Casts in Alopecia: A 2014 Study

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

This study observed that pigmented casts are present in various alopecia types but are not specific to any single diagnosis, with distinct morphological features noted in trichotillomania.

research A Comprehensive Approach to Hair Pathology of Horizontal Sections

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

This study reported that using photomnemonics facilitated accurate histopathologic interpretation of horizontal scalp sections in distinguishing between nonscarring and scarring alopecias by dermatopathologists and residents in a validation test.

Clinical and Histological Challenge in the Differential Diagnosis of Diffuse Alopecia: Female Androgenetic Alopecia, Telogen Effluvium and Alopecia Areata – Part I

research Clinical and Histological Challenge in the Differential Diagnosis of Diffuse Alopecia: Female Androgenetic Alopecia, Telogen Effluvium and Alopecia Areata – Part I

29 citations , October 2012 in “Anais Brasileiros De Dermatologia”

This review presents an objective analysis of female androgenetic alopecia, discussing clinical and dermoscopic examination approaches but reports no new clinical findings.

research Histopathology of Scarring and Nonscarring Hair Loss

17 citations , September 2012 in “Dermatologic Clinics”

This review discusses histologic findings in alopecia and emphasizes the importance of understanding normal follicular anatomy and cycles in transverse sections, without reporting new results.

research Dermoscopy-Guided Scalp Biopsy in Cicatricial Alopecia

62 citations , March 2012 in “Journal of the European Academy of Dermatology and Venereology”

This study found that dermoscopy-guided scalp biopsies provided a definitive pathological diagnosis in 95% of patients with cicatricial alopecia.

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

19 citations , September 2011 in “Clinical and Experimental Dermatology”

This study suggests that for single biopsy specimens, transverse sections may be preferable for diagnosing noncicatricial alopecia, while vertical sections may be better for suspected lichen planopilaris.

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

44 citations , January 2011 in “Journal of Cutaneous Pathology”

This study introduces the "HoVert" technique, which generates both vertical and horizontal sections from a single biopsy to effectively differentiate lichen planopilaris from discoid lupus erythematosus in alopecia cases.

research Histopathology of Alopecia: A Clinicopathological Approach to Diagnosis

170 citations , December 2009 in “Histopathology”

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.

research Hair Counts in Scalp Biopsy of Males and Females with Androgenetic Alopecia Compared with Normal Subjects

40 citations , June 2009 in “Journal of Cutaneous Pathology”

This study found that Iranian patients with androgenetic alopecia had a higher terminal to vellus hair ratio compared to previous studies in Whites, suggesting potential onset of miniaturization.

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 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 Quantitative Evaluation in Transverse Histological Sections of the Scalp

12 citations , June 2006 in “Anais Brasileiros de Dermatologia”

This study reports that scalp biopsies in white adults usually have 16.5 hair follicles, primarily in the anagen phase, with male samples showing fewer follicular units but more fibrous tracts in certain areas.

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.