Can scalp biopsies be wrong? Is there a possibility of me having Pseudopelade? (photos)

Question

I'm a 19yo female. I started losing hair in a uniform manner when I was 16 with no regrowth. I have lost about 75% hair now. My hair also parts on a side of the scalp now. I recently went to a doctor who thought that follicles on my parted side were atrophied and asked me to undergo a biopsy which came back positive. She has diagnosed me with Pseudopelade of Brocq. I also have low blood count, low serum ferritin (5) and low Vit D levels. Can I have Pseudopelade?

Jeff Donovan, MD, PhD · Answer

I can neither confirm not rule out the possibility you have pseudopelade. It is the combination of the clinical features (ie your whole story) plus the dermatoscopic appearance plus the biopsy details. The biopsy suggests scar tissue but does not confirm with 100 % certainty thr existence of pseudopelade. It would be helpful to know whether there are sebaceous glands present or not, as well as the appearance of special stains for scar tissue and elastin.  It would appear you have some degree of non scarring hair loss as well (such as androgenetic alopecia +|- telogen effluvium. I note that the biopsy or final diagnosis does not seen to take into account these entities. If you are not confident seek additional opinion from a dermatologist specializing in hair loss. You need to be aware that pseudopelade is not common so you will want to make sure your health care providers are very familiar with this entity. But to answer your first question... yes a biopsy can be wrong. Not wrong in the information it shows necessarily but wrong in that the biopsy interpretation is incorrect or that the sample is not representative of ehat is happening all over the scalp. It is not possible to comment further without examining the scalp myself.

William Rassman, MD (retired) · Answer

It seems that you are under the treatment of a dermatologist who did a biopsy and arrived at a diagnosis. If you don't believe it, then get a second opinion

Can scalp biopsies be wrong? Is there a possibility of me having Pseudopelade? (photos)

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Can scalp biopsies be wrong? Is there a possibility of me having Pseudopelade? (photos)

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Everything you need to know about Hair Loss Treatment

Our mission is to create a world where every investment in modern beauty is Worth It.