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What’s actually higher? Vertical or horizontal sectioning for scalp biopsies? — Donovan Hair Clinic

A pleasant examine from New Delhi in contrast the advantages of horizontal and vertical sections in precisely diagnosing scarring and non-scarring alopecia. The creator’s examine included 78 sufferers with alopecia – together with 43 with non scarring alopecia and 35 with scarring alopecia. The imply age was 27.7 years; the male: feminine ratio was 1.4:1, and the imply period of hair loss was 4.4 years.

The 43 circumstances of  non-scarring alopecia have been divided as follows: alopecia areata: 25; androgenetic alopecia: 16; persistent telogen effluvium and trichotillomania: 1 every.

 The 35 circumstances of cicatricial alopecia have been divided as follows: lichen planopilaris: 15; pseudopelade of Brocq: 12; discoid lupus erythematosus: 4; folliculitis decalvans: 3; linear morphea: 1.

Two Dermatopathologists evaluated the slides.



All in all of the authors discovered that the diagnostic accuracy of horizontal (transverse) sections was considerably greater than vertical sections for alopecia areata (97.7% and 86%, P = 0.05) and androgenetic alopecia (97.7% and 81.4%, P = 0.01). The outcomes have been related with each strategies for lichen planopilaris (vertical part = 100%; transverse part = 97.1%, P = 0.30) and pseudopelade of Brocq (vertical part = 100%; transverse part=97.1%, P = 0.30). 

 The authors discovered that higher element could possibly be ascertained from horizontal sections. For instance, catagen and telogen hairs, miniaturization have been discovered considerably extra typically in biopsied carried out utilizing transverse sections than vertical sections.

The authors discovered that 20 % of alopecia areata couldn’t be identified on vertical sections. Equally, in  androgenetic alopecia, miniaturisation was missed in 44 % of circumstances on vertical sections and in simply 6 % in horizontal sections. 

 General the authors proposed that horizontal and vertical sections have been equally useful for scarring alopecia whereas horizontal sections have been extra useful for diagnosing non scarring alopecia.



This can be a good examine. The controversy about horizontal and vertical sections continues in our subject. Some facilities use vertical sections as a result of they don’t know how you can put together horizontal sections and the pathology lab merely doesn’t have the abilities to arrange them. Some facilities use vertical sections as a result of the pathologist is extra snug studying vertical sections and has not been skilled in studying horizontal sections.

In 2016, a meta-analysis by Du et al printed within the European Journal of Dermatology didn’t discover a statistically vital distinction within the accuracy of horizontal and vertical sections. For evaluating non-scarring alopecia, there have been eight research inspecting using horizontal sections and eight inspecting using vertical part. The pooled diagnostic charges have been 0.81 (95% CI: 0.70-0.92) and 0.76 (95% CI: 0.60-0.93). For the prognosis of scarring alopecia, there have been three research inspecting using horizontal sections and 5 inspecting using vertical sectioning. The pooled diagnostic charges have been 0.86 (95% CI: 0.66-1) and 0.90 (95% CI: 0.82-0.98). General, the authors concluded that based mostly on printed research, no vital distinction existed between horizontal and vertical sectioning strategies within the prognosis of alopecia.

 There are a lot of elements which might be related after I ship my biopsy off to the lab. The primary is the pre-test chance of varied diagnoses. What do I believe the prognosis is earlier than sending it within the pathologist? The second is how good of a biopsy was it? Did I take if from a location on the scalp that actually has the options that I’m questioning about.

The third is the ability of the dermatopathologist. Does she or he get pleasure from studying pathology of hair and provides good report?

For scarring alopecia, it’s clear in my thoughts that glorious evaluations can come from each. It does appear that horizontal sections actually assist in difficult circumstances and early diagnoses. In alopecia areata, the horizontal sections can seize different findings that simply “peribulbar irritation” that we wait to see within the vertical sections. They will seize the shift in catagen hairs and the miniaturization. In AGA, the horizontal sections can superbly seize the T:V ratios that typically simply may be seen in vertical sections.

We most likely nonetheless have some debate left in us in regards to the utility of horizontal and vertical sections. Some centres take a single biopsy and carry out each kinds of cuts on a single biopsy. That is known as a Hovert method and was described in 2011 by Nguyen and colleagues.



Yadav et al. Vertical versus transverse sectioning in histopathological prognosis of alopecia: A comparative examine. Indian J Dermatol Venereol Leprol. 2022 Sep 17;1-4.

Du et al. Diagnostic worth of horizontal versus vertical sections for scarring and non-scarring alopecia: a scientific evaluate and meta-analysis. Eur J Dermatol . 2016 Aug 1;26(4):361-9. doi: 10.1684/ejd.2016.2797.

 Nguyen J et al. The HoVert method: A novel technique for the sectioning of alopecia biopsies. J Cutan Pathol. 2011;38:401–6.



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