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Alopecia
Alopecia
To maximize the diagnostic yield in the setting of alopecia, a 4-mm punch biopsy specimen should be obtained from a well-developed lesion, preferably of several monthsโ duration, but still active. Many labs prefer transverse sections, although serial vertical sections are superior in the setting of scarring alopecia. A separate biopsy can be bisected vertically to produce a half punch suitable for DIF and another half punch added to the formalin bottle to provide vertical sections. When biopsies of active lesions prove to be nondiagnostic, a biopsy from a scarred area evaluated with elastic tissue stains or polarized microscopy can provide additional information.23โ26 Both trichoscopy and confocal microscopy can be useful in site selection, directing the clinician to established areas of active inflammation.27โ29 The punch should always enter the scalp at the same angle as the emerging hairs to avoid transecting hair follicles. Hemostasis is more easily obtained with gel foam than with sutures.