My scalp biopsy report and would like to know best plan for me.

Question

I am posting the results of my scalp biopsy please read and tell me what treatment plan would work for me. my ferritin levels were 40 now they are 82 all the other test are fine. I am taking iron, spironolactone 100mg 2 times a day for 2 weeks now before that I took 50mg 2 times a day for 6 weeks. and I am eating very healthy and I am using scalp cortisone once a week I have very itchy and sore to touch scalp. I can see my scalp now would my hair grow back and what is the best treatment?

Jae Pak, MD · Answer

A scalp biopsy cannot tell you what your treatment should be.  Generally a doctor would need to examine you and also understand your goals.  Scalp biopsy basically says you have a non-scarring type of hair loss which is very non-specific.

Ryan Welter, MD · Answer

You biopsy report is showing evidence of a non scarring alopecia and is otherwise not definitive.  A trained specialist in hair needs to evaluate you to determine a full and appropriate diagnosis and you should have regular follow up to evaluate treatment methods.  In addition to traditional therapies which you have been using, cellular therapy has shown increased efficacy in treating non scaring alopecia.  I have been treating men and women with cellular therapies for the past 9 yeas with outstanding results.  Keep in mind that cellular preparations can vary so if you do have treatment be sure that you find an experience physician.  I have enclosed a journal article for your review.  This is specific to alopecia areata which is probably not what you have but in the same class of nonscoring inflammatory alopecia.  Hope it helps.

Jeff Donovan, MD, PhD · Answer

Contrary to many parts of medicine (where a biopsy is the final, inarguable answer), a scalp biopsy is not the "final step" in the diagnostic work up of hair loss. If one hands me a biopsy report without me seeing the patient (or at least knowing more about their history and seeing photos) ...  I'd never bet much on what the diagnosis really is. A scalp biopsy report needs to be combined with information from a careful history and detailed scalp exam. There are no exceptions. Every week, I see a patient or two with a biopsy report that reads scarring alopecia when they don't actually have a scarring alopecia. Every week I see a patent with a biopsy report that reads possible alopecia areata when they don't have alopecia areata and never did. Is that pathologist wrong? Is the biopsy incorrect? Not at all! A biopsy is just a tiny snapshot of what's happening deep down there beneath the scalp. It needs to be correlated with what's happening above the scalp. There are no exceptions.The biopsy presented here is helpful to confirm that your scalp itching and hair loss are not from a scarring alopecia.   This is not a typically biopsy report of a patient with lichen planopilaris, lupus, pseudopelade.  Nor is this a biopsy report of a patient with alopecia areata. The presence of full sebaceous glands and the absence of inflammation and the absence of perifollicular fibrosis confirm that this is not a scarring alopecia. But you need to present many, many more details to fill in the gaps. Only then can a treatment plan be advised.  Believe it or not, there are actually many causes of scalp itching and scalp pain that can't be picked up on a biopsy! So it all needs to be knitted together with the information your dermatologist gets from your medical history and a full scalp examination.For now, one can only say you likely have a "non scarring non inflammatory hair loss condition" with possible features of seborrheic dermatitis and genetic hair loss. Statistically speaking the most likely causes of this presentation are: female pattern hair loss with seborrheic dermatitis.But other possibilities exist.

William Rassman, MD (retired) · Answer

Your report is non-specific and of little help. Genetic hair loss runs in families on the woman's side
(mother, sister, grandmothers etc...), but most female hair loss occurs because
of some underlying cause such as birth control pills, some medications that are
used, and a variety of other diseases that shock the hair into miniaturization.
A typical knowledgeable doctor will examine you, determine the distribution of
your hair loss, see if it is uniform or patchy, take a careful history from you
and order a variety of blood tests to include the following. You must see a
good doctor for this assessment:

Sex Hormone tests

SHBG (Sex Hormone
Binding Globulin) used to test status of male hormones

Estradiol is a sex
hormone

FSH (Follicle
Stimulating Hormone) *not hair follicle but follicle in the ovary*

LH (Luteinizing
Hormone) is a sex hormone

Free Testosterone

Total Testosterone

ANA (Anti Nuclear
Antibody) used to test for Lupus or other autoimmune diseases

TSH (Thyroid
Stimulating Hormone) used to test for hyper or hypo-thyroid disease

Test Iron status

TIBC (Total Iron
Binding Capacity)

Ferritin

IronIf you are thinning, scalp Micropigmentation is a viable options, See web reference below

My scalp biopsy report and would like to know best plan for me.

Answers (4)

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