The current state of play in the histopathologic assessment of alopecia: two for one or one for two?

Abstract

The histopathologic assessment of a scalp biopsy for alopecia relies largely on the quality of the specimen provided for evaluation. There are a number of different protocols in the literature which have been proposed over the years, but no consensus has yet been reached as to the appropriate number of biopsies to be taken, or to which sectioning technique is the gold standard for achieving the best diagnostic yield. We herein review the pros and cons of the various protocols and share the experience with our St John's protocol.

Utility of horizontal and vertical sections of scalp biopsies in various forms of primary alopecias

“…[ 3 ] After employing this very protocol, Tailor et al . [ 16 ] observed a significant increase in the diagnostic yield of scalp biopsies.…”

Skin biopsy

“…In the setting of scarring alopecia, diagnostic yield can be improved if 2 biopsy specimens are taken from developed lesions. 31,32 One is bisected vertically, with one half placed in appropriate immunofluorescence media and the other half in formalin. The second specimen may be added to the same bottle intact or bisected transversely, 1 mm above the dermal/subcutaneous junction.…”

Is more hair always better? A single biopsy specimen is preferred for the evaluation of alopecia

“…We read with interest the recent article by Tailor et al, 1 which reviews the currently employed methods of alopecia specimen processing. The authors describe a variety of grossing techniques that include procedures that require one, two or three biopsy specimens to be obtained from the patient during a clinic visit to optimize the diagnostic process.…”