Utility of Horizontal Sections of Scalp Biopsies in Differentiating Between Androgenetic Alopecia and Alopecia Areata

January 2018 in “ Dermatology ”

Deepika Yadav, Sujay Khandpur, M Ramam, Manoj K. Singh, Vinod Sharma

androgenetic alopecia alopecia areata anagen:non-anagen hair ratio pigment casts horizontal sections scalp biopsies miniaturization of hair follicles peribulbar inflammation anagen catagen telogen AGA AA

Studysummary This study found that transverse sections of scalp biopsies, particularly looking at the anagen:non-anagen hair ratio and presence of pigment casts, effectively distinguish alopecia areata from androgenetic alopecia.

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

This study aimed to differentiate between androgenetic alopecia (AGA) and alopecia areata (AA) using horizontal sections of scalp biopsies. The study found that a lower anagen:non-anagen hair ratio and the presence of pigment casts in transverse sections of scalp biopsies favored AA over AGA. The study concluded that horizontal sections of scalp biopsies can be useful in differentiating between AGA and AA. The study also found that miniaturization of hair follicles was a common feature in both conditions, but significantly greater miniaturization was found in AA than AGA. Peribulbar inflammation was seen in significantly greater biopsies in AA than AGA. The anagen:non-anagen (catagen/telogen) ratio was also found to be an important quantitative histological feature.

View this study on karger.com →

Discuss this study in the Community →

Research cited in this study

15 / 15 results

research Distinguishing Diffuse Alopecia Areata from Pattern Hair Loss Using CD3+ T Cells

19 citations , February 2016 in “Journal of The American Academy of Dermatology”

This study found that the presence of CD3(+) T-cells within empty follicular fibrous tracts is a reliable indicator for diagnosing diffuse alopecia areata instead of pattern hair loss.

research Follicular Density and Ratios in Scarring and Nonscarring Alopecia

19 citations , February 2013 in “The American Journal of Dermatopathology”

This study found that follicular density and various hair growth ratios differ statistically between nonscarring and scarring alopecia, though significant overlap exists due to factors like sample size and scalp variation.

research An Atlas of Hair Pathology with Clinical Correlations, Second Edition

1 citations , January 2013 in “Dermatology practical & conceptual”

This review serves as a comprehensive guide to hair pathology with clinical correlations but does not provide new clinical results.

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.

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 , July 2012 in “International Journal of Trichology”

This study found that loss of contact between the arrector pili muscle and the hair follicle bulge may explain why hair loss in male and female pattern baldness is largely irreversible, unlike in alopecia areata.

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

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

This research retrospectively evaluated 92 skin specimens to propose histopathological criteria for diagnosing alopecia areata incognito, distinguishing it from telogen effluvium and androgenetic alopecia.

research Histologic Features of Alopecia Areata Other Than Peribulbar Lymphocytic Infiltrates

53 citations , September 2011

Other common signs, not just the well-known immune cells around hair bulbs, are important for diagnosing hair loss from alopecia areata.

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 Follicular Swiss Cheese Pattern: Another Histopathologic Clue to Alopecia Areata

35 citations , November 2010 in “Journal of Cutaneous Pathology”

This study reported that dilated follicular infundibula are a highly useful histopathologic criterion for diagnosing alopecia areata, particularly during its recovery stage.

research Histopathologic Profile of Alopecia Areata in Indian Patients

9 citations , January 2010 in “International Journal of Trichology”

This study found that in Alopecia Areata, increased non-anagen terminal follicles and peribulbar lymphocytic infiltrate are consistent histological features, even in cases that have progressed to scarring.

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 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 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 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.