Sinclair Rodney, Jolley Damian, Mallari Rica, Magee Jill
Skin and Cancer Foundation, University of Melbourne, Monash University, St Vincent's Hospital, Alfred Hospital, Melbourne, Victoria, Australia.
J Am Acad Dermatol. 2004 Aug;51(2):189-99. doi: 10.1016/s0190-9622(03)00045-8.
Chronic diffuse telogen hair loss is common in women. Paired 4-mm punch biopsy from the vertex scalp for horizontal and vertical sectioning is commonly used to distinguish between chronic telogen effluvium (CTE) and female pattern hair loss (FPHL). FPHL is now the favored term for androgenetic alopecia in women.
To evaluate the reliability of a single horizontally sectioned scalp biopsy in the diagnosis of FPHL, 207 women presenting with chronic diffuse hair loss had three 4-mm punch biopsy specimens taken from immediately adjacent skin on the mid scalp, and all 3 biopsy specimens were sectioned horizontally. Findings were compared with 305 women who underwent two biopsies, with one sectioned horizontally and the other vertically. The terminal to vellus-like hair ratio (T:V) at the mid-isthmus level was used to diagnose FPHL (T:V <4:1), CTE (T:V >8:1), or indeterminate hair loss (T:V=5:1, 6:1, or 7:1). To correlate the histologic diagnosis with the clinical severity, a mid-scalp clinical grading scale was developed.
Among the 305 women who had a single horizontal scalp biopsy, 181 (59%) were diagnosed as having FPHL, 54 (18%) having CTE, and 70 (23%) having indeterminate hair loss. Six hundred twenty-one horizontal biopsy specimens were assessed from 207 patients. On the basis of consensus over 3 biopsies, 159 (77%) were diagnosed as having FPHL, 44 (21%) having CTE, and the remaining 4 women (2%) as having indeterminate hair loss. Among these 207 women, 114 were assessed clinically as having stage 1 or 2 hair loss. Sixty-nine (60%) were diagnosed as having FPHL on the basis of triple biopsy, 42 (37%) having CTE, and 2 having indeterminate hair loss. Ninety-three were graded as having stage 3, 4, or 5 hair loss. FPHL was diagnosed in 90 women (97%), CTE in 2, and indeterminate hair loss in one. By using each single biopsy as the criterion for diagnosis, 398 (61%) were classified as FPHL, 99 (16%) as CTE, and 124 (20%) as indeterminate. In 493 biopsies (79%), the single biopsy conclusion was identical to the 3 biopsy conclusions. Where disagreement was seen (21%), most were classified as indeterminate, rather than as a wrong diagnosis (3.3%).
Application of these diagnostic criteria achieved accurate diagnostic definition in 98% of women with triple horizontal biopsies versus 79% with single horizontal biopsy. Ninety-seven percent of women with a mid-scalp clinical grade of 3, 4, or 5 were given a diagnosis of FPHL on triple biopsy. Scalp biopsy for diagnosis should be reserved for women with a mid-scalp clinical grade of 1 or 2.
慢性弥漫性休止期脱发在女性中很常见。通常采用从头顶头皮取4毫米打孔活检组织进行水平和垂直切片，以区分慢性休止期脱发（CTE）和女性型脱发（FPHL）。FPHL是目前女性雄激素性脱发的常用术语。
为评估单次水平切片头皮活检在诊断FPHL中的可靠性，对207例慢性弥漫性脱发女性患者，在头皮中部紧邻的皮肤处取3个4毫米打孔活检标本，并将所有3个活检标本进行水平切片。将结果与305例接受两次活检的女性进行比较，其中一次水平切片，另一次垂直切片。在峡部中部水平的终毛与毳毛样毛发比例（T:V）用于诊断FPHL（T:V<4:1）、CTE（T:V>8:1）或不确定型脱发（T:V=5:1、6:1或7:1）。为使组织学诊断与临床严重程度相关联，制定了头皮中部临床分级量表。
在305例接受单次水平头皮活检的女性中，181例（59%）被诊断为FPHL，54例（18%）为CTE，70例（23%）为不确定型脱发。对207例患者的621个水平活检标本进行了评估。基于对3次活检的共识，159例（77%）被诊断为FPHL，44例（21%）为CTE，其余4例女性（2%）为不确定型脱发。在这207例女性中，114例临床评估为1期或2期脱发。基于三次活检，69例（60%）被诊断为FPHL，42例（37%）为CTE，2例为不确定型脱发。93例被分级为3期、4期或5期脱发。90例女性（97%）被诊断为FPHL，2例为CTE，1例为不确定型脱发。以每次单次活检作为诊断标准，398例（61%）被分类为FPHL，99例（16%）为CTE，124例（20%）为不确定型。在493次活检（79%）中，单次活检结论与三次活检结论相同。在出现分歧的情况（21%）中，大多数被分类为不确定型，而非错误诊断（3.3%）。
应用这些诊断标准，在98%的接受三次水平活检的女性中实现了准确的诊断定义，而单次水平活检的这一比例为79%。在三次活检中，97%的头皮中部临床分级为3期、4期或5期的女性被诊断为FPHL。头皮活检诊断应仅用于头皮中部临床分级为1期或2期的女性。
