Whiting, 1993  Title: Diagnostic and predictive value of horizontal
sections of scalp biopsy specimens in male pattern androgenetic
alopecia.
Author: Whiting DA
Journal: J Am Acad Dermatol 1993 May;28(5 Pt
1):755-63. Published erratum appears in J Am Acad Dermatol 1993
Oct;29(4):554
PMID: 8496421, UI: 93266893
Affiliated institution: University
of Texas, Southwestern Medical Center, Dallas.
Cited in: Dierickx
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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