Case Number : Case 2179 - 16 October 2018 Posted By: Uma Sundram

Variation in follicle size with miniaturization,  preserved adnexae and absence of inflammation and fibroplasia suggest female pattern baldness. 

Im not an expert in Alopecia but mi first impression is Female Androgenetic Alopecia (FAGA)

yes Female Androgenetic alopecia

But I am surprised why biopsy was done

am I missing something

Yes, androgenetic alopecia. It was such a classic that I wanted to post it.  SInce we don't get many alopecia cases, I thought this would be a good teaching case! The biopsy was performed to exclude other causes of alopecia.

Interesting case for me!!! Thanks Uma!

Thanks Uma. Yes agree we should be posting alopecia cases a bit more as our clinicians here only biopsy rarely so we all learn from the relatively few and the somewhat challenging cases we see. I prefer "androgenic" personally! "androgenetic" sounds like a genetic disorder but I guess you could argue it is of course.

Good talk from Tim McCalmont on the alopecias in Sau Paulo. I asked if we could basically drop the vertical sections and he pretty much agreed once you''ve done your learning curve with the horizontals there is very little need for the vertical - bearing in mind you'd occasionally have to level up and down as appropriate. We tend to look at the first 3 levels and can often give a diagnosis in 50% and only do the more extensive step levels (I do L4-12 at 150 micron steps) as required.

I've heard "experts" in public talking about serial sections and looking at 100's of levels which I've never been inclined to do as the horizontals give you every follicle in the biopsy different levels. You either know what it is or you don't. Obsessively close levels/serial sections rarely help in any situation in dermatopathology (sprotrichosis perhaps could be an exception to find the microorganism in the centre of the granuloma) but even then culture is the gold standard and the diagnosis should be suspected with the appropriate pathologoy and a negative fungal stain.