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

September 2011 in “ Clinical and Experimental Dermatology ”

Deren Özcan, Özlem Özen, Dilek Seçkin

alopecia noncicatricial alopecia cicatricial alopecia lichen planopilaris scalp biopsy transverse sections vertical sections

TLDR 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.

In the 2011 pilot study involving 53 patients with alopecia, transverse sections of scalp biopsy specimens were found to be more sensitive for diagnosing noncicatricial alopecia, with a 100% sensitivity rate, compared to 83.3% for vertical sections. For cicatricial alopecia, vertical sections had a slightly higher sensitivity (82.4%) than transverse sections (76.5%). The study suggested that transverse sections are more effective for noncicatricial alopecia, while vertical sections are better for diagnosing lichen planopilaris within the cicatricial group. However, the study had limitations, including a small sample size for certain alopecia types, no assessment of interobserver reliability, and potential recall bias. Overall, the study concluded that transverse sections may be preferable for diagnosing noncicatricial alopecia of an unknown type, while vertical sections should be used for suspected lichen planopilaris, and either method could be suitable for other types of cicatricial alopecia when lichen planopilaris is clinically unlikely.

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