头皮活检标本水平切片在男性型雄激素性脱发中的诊断和预测价值

Diagnostic and predictive value of horizontal sections of scalp biopsy specimens in male pattern androgenetic alopecia.

作者信息

Whiting D A

机构信息

University of Texas, Southwestern Medical Center, Dallas.

出版信息

J Am Acad Dermatol. 1993 May;28(5 Pt 1):755-63. doi: 10.1016/0190-9622(93)70106-4.

DOI:10.1016/0190-9622(93)70106-4

PMID:8496421

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.

摘要

背景

小头皮活检标本的垂直切片通常不足以诊断男性型雄激素性脱发（MPAA）。水平切片中毛囊结构的定量分析可提供更多信息。

目的

我们的目的是通过比较MPAA患者和正常对照者头皮活检标本的水平和垂直切片来建立更好的诊断标准，并通过将MPAA中毛囊结构的计数与局部米诺地尔治疗后的后续头发生长相关联来确定水平切片的预测价值。

方法

从22名正常对照者和106名MPAA患者中获取配对的4毫米打孔活检标本，进行水平和垂直切片。在水平切片中，计数毛球、生长期终毛、退行期和休止期毛发、休止期生发单位和毳毛，以及毛囊单位和柱。

结果

通过发现终毛减少、柱和毳毛增加来确诊MPAA。平均水平切片包含22根终毛和13根毳毛，比例为1.7:1。大多数垂直和水平切片中都发现了与MPAA相符的变化，但毛囊计数需要水平切片，并且在67% 的病例中显示终毛与毳毛的比例可诊断MPAA。在44名接受局部米诺地尔治疗的患者中，每平方毫米毛囊结构少于2个的5名患者没有头发生长，每平方毫米有2至4个毛囊结构的32名患者中有72% 出现头发生长，每平方毫米毛囊结构多于4个的7名患者中有86% 出现头发生长。在无明显炎症的MPAA中，77% 的病例出现头发生长，而有明显炎症的病例中这一比例为55%。