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Diagnostic and predictive value of horizontal sections of scalp biopsy specimens in male pattern androgenetic alopecia.
J Am Acad Dermatol. 1993 May; 28(5 Pt 1):755-63.JA

Abstract

BACKGROUND

Vertical sections of small scalp biopsy specimens are often inadequate for the diagnosis of male pattern androgenetic alopecia (MPAA). Quantitative analysis of follicular structures in horizontal sections can provide more information.

OBJECTIVES

Our purpose was to establish better diagnostic criteria by comparing horizontal and vertical sections of scalp biopsy specimens from MPAA and normal control subjects and to determine the predictive value of horizontal sections, by relating counts of follicular structures in MPAA to subsequent hair regrowth from topical minoxidil therapy.

METHODS

Paired 4 mm punch biopsy specimens were taken from 22 normal control subjects and 106 patients with MPAA, for horizontal and vertical sectioning. In horizontal sections, hair bulbs, terminal anagen, catagen and telogen hairs, telogen germinal units, and vellus hairs were counted, as were follicular units and stelae.

RESULTS

The diagnosis of MPAA was confirmed by finding decreased terminal hairs and increased stelae and vellus hairs. The average horizontal section contained 22 terminal and 13 vellus hairs, a 1.7:1 ratio. Changes compatible with MPAA were found in most vertical and horizontal sections, but horizontal sections were required for follicular counts and showed terminal:vellus hair ratios diagnostic of MPAA in 67% of cases. Of 44 patients treated with topical minoxidil, five with less than 2 follicular structures/mm2 showed no hair regrowth, 32 with 2 to 4 follicular structures/mm2 showed regrowth in 72%, and seven with more than 4 follicular structures/mm2 showed regrowth in 86% of cases. In MPAA with no significant inflammation, regrowth occurred in 77% of cases, versus 55% in cases with significant inflammation.

CONCLUSION

Horizontal sections of scalp biopsy specimens in MPAA provide more diagnostic information than vertical sections and appear to have a predictive value for hair regrowth.

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Publisher Full Text

Authors+Show Affiliations

Whiting DA
University of Texas, Southwestern Medical Center, Dallas.

MeSH

Administration, CutaneousAdolescentAdultAgedAlopeciaBiopsyCollagenFemaleFibrosisFolliculitisHairHistiocytesHumansLymphocytesMaleMiddle AgedMinoxidilPredictive Value of TestsRegenerationScalp

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8496421

Citation

Whiting, D A.. "Diagnostic and Predictive Value of Horizontal Sections of Scalp Biopsy Specimens in Male Pattern Androgenetic Alopecia." Journal of the American Academy of Dermatology, vol. 28, no. 5 Pt 1, 1993, pp. 755-63.
Whiting DA. Diagnostic and predictive value of horizontal sections of scalp biopsy specimens in male pattern androgenetic alopecia. J Am Acad Dermatol. 1993;28(5 Pt 1):755-63.
Whiting, D. A. (1993). Diagnostic and predictive value of horizontal sections of scalp biopsy specimens in male pattern androgenetic alopecia. Journal of the American Academy of Dermatology, 28(5 Pt 1), 755-63.
Whiting DA. Diagnostic and Predictive Value of Horizontal Sections of Scalp Biopsy Specimens in Male Pattern Androgenetic Alopecia. J Am Acad Dermatol. 1993;28(5 Pt 1):755-63. PubMed PMID: 8496421.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic and predictive value of horizontal sections of scalp biopsy specimens in male pattern androgenetic alopecia. A1 - Whiting,D A, PY - 1993/5/1/pubmed PY - 1993/5/1/medline PY - 1993/5/1/entrez SP - 755 EP - 63 JF - Journal of the American Academy of Dermatology JO - J Am Acad Dermatol VL - 28 IS - 5 Pt 1 N2 - BACKGROUND: Vertical sections of small scalp biopsy specimens are often inadequate for the diagnosis of male pattern androgenetic alopecia (MPAA). Quantitative analysis of follicular structures in horizontal sections can provide more information. OBJECTIVES: Our purpose was to establish better diagnostic criteria by comparing horizontal and vertical sections of scalp biopsy specimens from MPAA and normal control subjects and to determine the predictive value of horizontal sections, by relating counts of follicular structures in MPAA to subsequent hair regrowth from topical minoxidil therapy. METHODS: Paired 4 mm punch biopsy specimens were taken from 22 normal control subjects and 106 patients with MPAA, for horizontal and vertical sectioning. In horizontal sections, hair bulbs, terminal anagen, catagen and telogen hairs, telogen germinal units, and vellus hairs were counted, as were follicular units and stelae. RESULTS: The diagnosis of MPAA was confirmed by finding decreased terminal hairs and increased stelae and vellus hairs. The average horizontal section contained 22 terminal and 13 vellus hairs, a 1.7:1 ratio. Changes compatible with MPAA were found in most vertical and horizontal sections, but horizontal sections were required for follicular counts and showed terminal:vellus hair ratios diagnostic of MPAA in 67% of cases. Of 44 patients treated with topical minoxidil, five with less than 2 follicular structures/mm2 showed no hair regrowth, 32 with 2 to 4 follicular structures/mm2 showed regrowth in 72%, and seven with more than 4 follicular structures/mm2 showed regrowth in 86% of cases. In MPAA with no significant inflammation, regrowth occurred in 77% of cases, versus 55% in cases with significant inflammation. CONCLUSION: Horizontal sections of scalp biopsy specimens in MPAA provide more diagnostic information than vertical sections and appear to have a predictive value for hair regrowth. SN - 0190-9622 UR - https://www.unboundmedicine.com/medline/citation/8496421/Diagnostic_and_predictive_value_of_horizontal_sections_of_scalp_biopsy_specimens_in_male_pattern_androgenetic_alopecia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/0190-9622(93)70106-4 DB - PRIME DP - Unbound Medicine ER -