help understanding biopsy results

[SadMom]

I had a biopsy done in August. Was told over the phone it was Androgenetic Alopecia. But I've recently gotten a copy of the results, and I'm not sure it's that cut and dried. If someone could help me understand these comments it would be great!

Seems to me my hairloss looks a lot like Telogen Effluvium, except for some vellus hairs. But I read that in CTE, you can get those too. I've had temple recession like in CTE. Plus, my part is equally as wide anywhere on my scalp. I am very thin all over. My stylist agrees, and says she can see some regrowth equally all over too. My regrowth is pretty sparse though.


Here are the results from my scalp biopsy.

"There are numerous follicles within the deep dermins and subcutaneious tissue. Follicular plugging is present. There are increased numbers of miniturized pilosebaceous units (vellus hairs) present. In addition, a number of follicles are in the telogen phase, while a rare follicle is in the anagen phase. Occasional fibrous *streamers* are identified in the subcutaneous tissue. There is a chronic inflammatory infiltrate within the superficial and mid dermis, surrounding some adnexal structures. No inflammation is seen within follicles. "

Comment.... Changes most consistent with androgenetic alopecia.

The histologic changes are somewhat overlapping with diffuse alopecia. Although there is still good preservation of telogen hairs, the presence of miniaturization slightly favor Androgenetic Alopecia.


me again....

what does that mean, slightly favor Androgenetic Alopecia? Does that mean it isn't clear? Or that more than one thing is going on? Could it NOT be Androgenetic Alopecia? Or does the vellus hairs mean is has to be? I'm very confused!

 

[Guest]

Hi SadMom,

Unfortunately Telogen Effluvium does not have miniaturized hairs, miniaturization is only present with Androgenetic Alopecia.

In terms of the histologic overlapping of diffuse alopecia, "In women with diffuse loss of greater than six months duration, the majority of cases are due to Androgenetic Alopecia and CTE2." http://www.oxfordhairfoundation.org/news/soapboxstory/95.htm and http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&dopt=Abstract&list_uids=90381181

My humble interpretation after reading your post is that it seems as if you have diffuse alopecia (as noticed by you and your hair dresser) with androgenetic alopecia (shown by the presence of miniaturized hairs).

Laura

 

[Guest]

I thought that Telogen Effluvium didn't have miniaturized hairs either. But on Keratin.com, Kevin talks about how in some cases of chronic Telogen Effluvium, there can be. So, that confused me.

So, you are saying, I'm unlucky enough to have 2 forms of hairloss going on? I know why the Androgenetic Alopecia would be happening, biologically, and I'm doing some things to hopefully change this. But I don't know why the Telogen Effluvium. How on earth do I find out what's causing that so I can fix it? I can't afford to keep losing hair due to two reasons. One is bad enough.

 

[HairlossTalk]

The bottom line here is that there is no definitive diagnostic test for women's hair loss. It is as much a guessing game for doctors as it is for lay people. Educated guesses are helpful, and reading the "signs" and "trends" of your particular situation will also help.

Trying to determine whether this is Telogen Effluvium or Androgenetic Alopecia may just drive you insane. The fact is, Telogen Effluvium is experienced with Androgenetic Alopecia and Androgenetic Alopecia can look like Telogen Effluvium. Unless you're working with an electron microscope and analyzing your growth and resting cycles with one on a daily basis for several months, you can't really definitively know which it is.

Ask yourself what the value is of knowing if you have one or the other. What would you do differently? The treatment regimen for a woman with Telogen Effluvium is to use a growth stimulant like Minoxidil. The treatment regimen for a woman with Androgenetic Alopecia is to use a growth stimulant ... like Minoxidil.

Really, the only value of knowing which is which, is to maybe have different expectations on whether this will reverse itself over time, or not. If you experienced noticeable loss after pregnancy, this is incredibly common, and it makes absolute total sense to attribute it to the pregnancy. This type of hair loss is 99% of the time automatically reversible, but there are women who have a different hormonal balance after pregnancy as well, and this can lead to ongoing issues with hair.

In this sense, Androgenetic Alopecia could technically be "acquired". Pregnancy does a number on a woman's body. My mother's hair literally went from totally straight, to curly, after she had me. It has remained so until this day, 30 years later.

HairLossTalk.com

 

[Guest]

Reality

Well - I'm not a doctor and do not claim to be at all. Nor do I claim to have a grip on my own situation. But looking at your biopsy it does seem to favor Androgenetic Alopecia with Telogen Effluvium. And yes, you can have both. I think I'm in the same boat. At least you were able to get a biopsy - I can't even get some of the doctors I've been to give me that.

A biopsy is more definitive. If you still feel confused - get another opinion from a medical professional. And pray for the best but expect the worst. If you've got Androgenetic Alopecia than you've got it. And lets face it ladies - it's not Aids or Terminal Cancer. Yes, it sucks out loud but it could be a million times worse.

That said, you can also go online with your biopsy results and submit them to Answersoft.com. They have a medical advisory board where three doctors give you opinions on test results. It cost $20.00 but I believe it was worth it. I've done it twice and was impressed with the results. There are also other boards with discussion forums like this one keratin.com, hairsite.com, etc... they might be able to help you. And these boards, people tend to answer back. You're biopsy to me isn't too convoluted. Again, I think you have both Androgenetic Alopecia and Telogen Effluvium.

Have you changed your diet? Sometimes this may help. Supplements, natural progesterine cream (hormonal imbalanced), reflexology, and spironolactone for Androgenetic Alopecia. I could go on. Some of this may work and some of it may not. It's a crap shoot. But good luck.