Location, Location, Location: Lessons for Harriet Hoppity

Where One Looks Influences What One Finds

Let’s take a look together at the story of Harriet. The legendary story helps us all understand the importance of precision when it comes to choosing specific locations on the scalp to examine or to biopsy.

Ms Harriet Hoppity loves to eat dandelions. She was told that there were plenty of dandelions to be found in a local field and so she and her friends decided to hop over there. 

Upon arrival at the field, Ms Harriet Hoppity chooses to look west rather than east and expresses immediate disappointment that she can not find any dandelions. She then hops back home. Upon arrival back home, the locals inform her that all the delicious dandelions were to be found in the field to the east. 

Ms Harriet’s legendary story has many good lessons for the hair loss community. What you find depends on where you choose to look and where you choose to look depends on your past knowledge and past experiences. 

Some scalp biopsies of hair loss do not end up showing the actual true diagnosis because the sample was taken from an area that does not have the disease.  For example, a biopsy from the sides or back of the scalp is not usually as helpful if one is looking to confirm a diagnosis of androgenetic alopecia. 

Sometimes a disease is patchy and even slight differences in where the biopsy is taken can give different results. That is especially true of inflammatory conditions like lichen planopilaris and even non-scarring ones like seborrheic dermatitis. A biopsy 2 cm over to the left could have slightly different results - either more helpful information or less helpful information.