Abstract
Primary cicatricial alopecias (PCA) represent a challenging group of disorders that result in irreversible hair loss from the destruction and fibrosis of hair follicles. Scalp skin biopsies are considered essential in investigating these conditions. Unfortunately, the recognised complexity of histopathologic interpretation is compounded by inadequate sampling and inappropriate laboratory processing. By sharing our successes in developing the communication pathway between the clinician, laboratory and histopathologist, we hope to mitigate some of the difficulties that can arise in managing these conditions. We provide insight from clinical and pathology practice into how diagnoses are derived and the key histological features observed across the most common PCAs seen in practice. Additionally, we highlight the opportunities that have emerged with advances in digital pathology and how these technologies may be used to develop clinicopathological relationships, improve working practices, enhance remote learning, reduce inefficiencies, optimise diagnostic yield, and harness the potential of artificial intelligence (AI).
Highlights
This has been illustrated by comparing Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA); two clinically distinctive entities which appear to display both shared and divergent pathogenesis, likened to the trunk and branches, respectively, of the same “pathogenesis tree” [24]
Histological findings cannot distinguish between LPP and FFA [23]; howearly loss of vellus hairs in the frontal hairline in FFA is a useful clinical clue to diagnosis, ever, certain characteristics reportedly differ between the two entities: FFA shows more helping to differentiate FFA from androgenetic alopecia, whilst providing insight into the prominent apoptosis, less inflammation, deeper inflammation and sparing of the interfolpathological process that result in this presentation [42,43]
premature desquamation of the internal root sheath (PDIRS) in non-inflamed hair follicle (HF) occurred in 73% of cicatricial alopecia (CCCA), but only 33% of psoriatic alopecia, 11% of folliculitis decalvans, and
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The key to successful treatment is securing a robust diagnosis. These conditions frequently pose diagnostic challenges to both dermatologists and pathologists alike, with misdiagnosis risking exposing patients to inappropriate or futile treatment strategies. Appropriate biopsy site selection along with close communication between the clinician and histopathologist will improve the chance of an accurate diagnosis and is considered advantageous in determining the procedural approach and management plan for these complex patients [1,2]. We provide guidance on biopsy site selection, and how tissue sampling and laboratory processing can be optimised to help differentiate between different scarring hair loss types. We hope this review will provide a pathway to the successful management of these challenging cases and explore how advances in such technology could transform diagnostic histopathology.
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