Does a biopsy guide how hair loss is treated?

Biopsies Guide Diagnosis and Diagnosis Guides Treatment.

I’ve selected this question below for this week’s question of the week. It allows us to review some concepts regarding the role of the scalp biopsy.

Question

I am wondering if a biopsy could in some way help guide the treatment path that I take?

Answer

That answer is yes - but indirectly !
It’s important to understand that the first thing I ask when deciding on treatment is: What is the diagnosis of the patient’s hair loss?

The treatment of hair loss depends 100 % on the diagnosis. If one does not confidently know the diagnosis, then treatment can not begin. A scalp biopsy can in some cases help with getting to the correct diagnosis. But a biopsy must be interpreted in context with the patient’s story and examination. We never diagnosis hair loss based on a biopsy alone. (See: “Scalp Biopsies Lead to a Scalp Biopsy Report Not A Final Diagnosis”)

The Scalp Biopsy Guides The Diagnosis and the Diagnosis then Guides Treatment.

If the diagnosis is confidently known, it’s not all that often that a biopsy is going to change how it’s treated.

a) If the patient has alopecia areata, the doctor can tell by examining the scalp what treatments are most likely to work and which treatment are least likely to work. A biopsy does not change that. However, if the doctor is not really sure if the patient has alopecia areata or not, then a biopsy might be considered.

b) If the patient has scarring alopecia, the doctor can tell by examining the scalp what treatments are most likely to work and which treatment are least likely to work. A biopsy does not change that - usually. (Sometimes the degree of inflammation might sway some practitioners to choose one treatment over another - but that’s not that common). However, if the doctor is not really sure if the patient has scarring alopecia or not, then a biopsy should be considered.

c) If the patient has androgenetic alopecia, the doctor can tell by examining the scalp what treatments are most likely to work and which treatment are least likely to work. A biopsy does not change that. However, if the doctor is not really sure if the patient has andrgoenetic alopecia or not, then a biopsy should be considered.

All in all, the biopsy helps in some cases to solidify the diagnosis. It’s the diagnosis that then guides treatment.