Histopathology of alopecia: A clinicopathological approach to diagnosis

Department of Dermatopathology, St John's Institute of Dermatology, St Thomas' Hospital, London, UK.
Histopathology (Impact Factor: 3.45). 01/2010; 56(1):24-38. DOI: 10.1111/j.1365-2559.2009.03439.x
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Stefanato C M (2010) Histopathology56, 24–38 Histopathology of alopecia: a clinicopathological approach to diagnosis
Interpretation of the histopathological findings of primary scarring and non-scarring alopecias may prove daunting. This is especially true if the biopsy specimen is inadequate, and the clinical history and pattern of the alopecia are not known. Common forms of scarring alopecias discussed here are the lymphocytic (discoid lupus erythematosus, lichen planopilaris, central centrifugal cicatricial alopecia, pseudopelade of Brocq), the neutrophilic (folliculitis decalvans, dissecting folliculitis), and the mixed (acne keloidalis) entities. The non-scarring alopecias reviewed are androgenic alopecia, telogen effluvium, alopecia areata, trichotillomania and traction alopecia. In all cases of primary alopecia, adequate tissue sampling and appropriate laboratory processing, in combination with pertinent clinical information, provide the key to diagnosis.

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    • "In addition, in this study, the lack of follicular ostia was frequently observed in cases of scarring alopecia such as DLE, LPP, and PB. For alopecia, the discrimination between scarring alopecia and nonscarring alopecia may take precedence over the others7. However, few diseases considered nonscarring alopecia could be misdiagnosed as scarring alopecia8. "
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    ABSTRACT: BackgroundVarious kinds of alopecia can show small round or oval hairless patch. Dermoscopy could be a simple, useful tool for making a correct diagnosis.ObjectiveThe aim of this study is to investigate clinical usefulness of dermoscopy for diseases with small round or oval hairless patch on the scalp.MethodsDermoscopic examination was performed for 148 patients with small round or oval hairless patch using DermLite® II pro. The type and its patient number of alopecia investigated in the study were as below: alopecia areata (n=81), trichotillomania (n=24), tinea captis (n=13), traction alopecia (n=12), lichen planopilaris (n=8), discoid lupus erythematosus (n=7), congenital triangular alopecia (n=2) and pseudopelade of Brocq (n=1). The significance of dermoscopic findings for each disease were evaluated.ResultsCharacteristic dermoscopic findings of alopecia areata were tapering hairs and yellow dots. Those of trichotillomania and traction alopecia were broken hairs. Dermoscopic findings of tinea capitis included bent hairs, perifollicular white macules and greasy scales. Discoid lupus erythematosus and lichen planopilaris were characterized by dermoscopic findings of lack of follicular ostia. Furthermore, keratin plugs were frequently seen in discoid lupus erythematosus whereas perifollicular hyperkeratosis and erythema were frequently seen in lichen planopilaris.ConclusionDermoscopic examination for small round or oval hairless patch showed characteristic findings for each disease. Based on these results, we propose dermoscopic algorithm for small round or oval hairless patch on the scalp.
    Annals of Dermatology 04/2014; 26(2):214-20. DOI:10.5021/ad.2014.26.2.214 · 1.39 Impact Factor
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    • "Thus, only 10% of the follicles present in the specimen will be visualized. 17 Horizontal or transverse biopsy is best taken by a 4 mm punch biopsy 1–1.5 mm below the epidermal–dermal junction and yields follicular pathology and a quantitative approach to diagnosis.16 Horizontal biopsy also allows complete evaluation of the hair follicles throughout their entire length.17 "
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    ABSTRACT: Hair loss is a very common complaint. Patients may describe increased shedding and diffuse or localized alopecia. The differential diagnosis of hair loss includes a number of disorders causing cicatricial or noncicatricial alopecias. This paper describes the clinical approaches and diagnostic tests that are useful in the evaluation of patients presenting with alopecia. It also reviews treatments for noncicatricial alopecias, including androgenetic alopecia, alopecia areata, and telogen effluvium, as well as cicatricial alopecias, including lichen planopilaris, its clinical variant frontal fibrosing alopecia, and discoid lupus erythematosus.
    Clinical, Cosmetic and Investigational Dermatology 07/2011; 4:101-6. DOI:10.2147/CCID.S10182
    • "AA is a clinically distinctive form of ‘non-scarring’ alopecia that is rarely biopsied and hence, many pathologists are unfamiliar with its interpretation. In addition, literature stresses that transverse sections are a must for establishing a correct diagnosis, which are not done in most laboratories.[3] The role of a pathologist is vital when dealing with atypical presentations, such as patients progressing to scarring, use of topical medications that alter the picture and of late, in trying to provide prognostic information. "
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    ABSTRACT: Alopecia Areata (AA) is a "non-scarring" alopecia that has an autoimmune basis. Though clinically distinctive, problems arise in diagnosis depending on the temporal stage of the disease at presentation; some of them progress to scarring alopecia and predicting its prognosis is difficult. Histological changes depend on the disease stage and site of the biopsy. To describe the spectrum of histologic features in AA. A prospective and retrospective study of H and E sections of all biopsies signed out as AA between 2001 and 2009 (20 cases) was undertaken. The diagnosis was made on vertical sections in all cases. The total number of hair follicles ranged from 1 to 24 with an average of 7 and comprised mainly terminal follicles. Vellus follicles were scanty. Anagen to non-anagen ratio was 1:1.62. Miniaturization of follicles was noted in five (25%) cases. Peribulbar inflammation was seen in all the cases with a dominance of lymphocytes. Perifollicular fibrosis was noted in 12 (60%) and pigment casts in 5 (25%) cases. Scarring was seen in two cases. In these cases, a diagnosis of AA was rendered on the basis of even spacing of the fibrotic units and remnants of the catagenic basement membrane within the scars. The epidermis and interfollicular dermis were normal in all the cases. The most consistent features of AA are an increase in non-anagen terminal follicles and peribulbar lymphocytic infiltrate. The etiology can be determined even in cases that have progressed to scarring.
    International Journal of Trichology 03/2010; 2(1):14-7. DOI:10.4103/0974-7753.66906
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