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Hair thinning - no recession (that I can see)
02-24-2017, 03:32 PM
Post: #1
Hair thinning - no recession (that I can see)
Hi - I recently started to notice hairfall - I'm not sure if it is excessive or not, but it triggers my OCD - I went to a GP and he said there are no signs of androgenic alopecia and all my blood work checks out - so I went to a dermatologist to get more info. She said she doesn't see any signs either but ordered a biopsy at my request. I have included the results below. She feels the diagnosis is incorrect because she think that they are looking for a reason for hairfall and that androgenic alopecia is the most likely cause, but that we can't determine if there is actually even excessive hairfall in the first place (she doesn't have a baseline measure and my perception is skewed thanks to OCD). What do you make of the results? She suggested I view my progression in 6 months but I'm thinking I should get a bigger biopsy done. She said her guess is that my hair will not progress and that she can't see any miniaturisation or empty follicles under dermoscope.

I have very minimal family history of hairloss - my dad and both my grandfathers have their hair - it's only thinned now that my grandfather is almost 90.

Here is the biopsy.

The patient is a 28 year old man with severe anxiety and obsessive compulsive disorder. He has presented with a 2-month history of perceived thinning of the scalp hair, particularly over the central vertex. He has noticed increased hair loss per day. There is a suggestion of a peripilar halo on dermoscopy. Early androgenic alopecia is suspected. Inflammatory hair disorders, however,
are to be excluded.

MACROSCOPY
The specimen comprises a skin punch biopsy measuring 4-5mm in diameter. Only a single punch biopsy was received, rather than two separate punch biopsies for vertical and horizontal sectioning.

MICROSCOPY
See "Diagnosis" below.
DIAGNOSIS
Skin punch biopsy from the SCALP -
- Absence of overt pathological alterations in the limited number of
sections examined thus far.
- FINAL DIAGNOSIS DEFERRED pending examination of additional serial
sections in the vertical and horizontal planes.
- Kindly await the ADDENDUM REPORT, which will be issued as soon as
possible.

ADDITIONAL HISTOLOGICAL SECTIONS :
Since only a single punch biopsy was received, the specimen was initially
embedded for vertical serial sectioning. Thereafter, the biopsy was bisected

nd re-embedded for examination of serial sections in the horizontal plane.
The fact that only a single biopsy was submitted, however, means that only a
limited number of follicular units could be examined horizontally, thus
hampering confident and meaningful assessment of the relative proportion of
anagen, catagen and telogen hair follicles. Increased numbers of catagen and/
or telogen follicles, however, are not readily apparent. Furthermore, there
are no histological features to suggest hair follicle drop-out as a consequence
of a cicatricial process. There are no intrafollicular pigment casts, and
there is no foreign body giant cell granulomatous reaction to elaborated hair
shaft material. Only occasional stellae are seen. A peribulbar lymphocytic
infiltrate is not apparent. No more than a negligible superficial
perifollicular mononuclear infiltrate is observed in the upper dermis. There
is retention of the normal contingent of sebaceous glands. Although widespread
miniaturization of follicles is not observed, there is nevertheless a focal
suggestion of the latter.
CONCLUSION :
Skin punch biopsy from the SCALP VERTEX -
- Subtle histological features, which are SUGGESTIVE but not
definitively diagnostic of EARLY ANDROGENIC ALOPECIA.
- NO evidence of scarring alopecia in the sections examined.
[See "Comment" below]
COMMENT :
A definitive diagnosis has proven difficult in this case, as the disease
process appears to be in an early stage of evolution, and only a single punch
biopsy was submitted for histological assessment. Ideally, two separate punch
biopsies, each with a minimum diameter of 4mm are required for horizontal and vertical tissue sectioning, as this facilitates more accurate calculation of the relative proportion of anagen, catagen and telogen hair follicles. Careful clinico-pathological correlation is required. Follow-up biopsy in the event of disease progression merits consideration.
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05-01-2017, 02:06 AM
Post: #2
RE: Hair thinning - no recession (that I can see)
Hi Nich,

So are you looking for solution to your hair thinning?

EricOng
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