Related Experiment Video
Updated: Jul 30, 2025
A New Technique for Quantitative Analysis of Hair Loss in Mice Using Grayscale Analysis
Published on: March 9, 2015
The modified HoVert (mHoVert) method improves diagnostic certainty compared to the St John's protocol for alopecia
Laura Adams1,2, Alexander Amphlett1,3, Emma Gardette1
1Royal Free Hospital, London, UK.
Background:
Access to vertical and transverse sections of a punch biopsy specimen improves the diagnosis of alopecia. Both two biopsy specimen and single-punch biopsy specimen techniques to visualize both transverse and vertical sections have been described. Their comparative diagnostic certainty is not known. We aimed to assess the diagnostic certainty of a modified HoVert (mHoVert) method, without direct immunofluorescence (DIF), compared to the St John's protocol, a two-biopsy technique with DIF.
Methods:
Fifty-seven cases of alopecia processed using the St John's protocol and 60 cases of alopecia processed using mHoVert were reviewed. Diagnoses made were rated as certain/probable, possible, or uncertain, depending on the language in the histopathology report. Cases processed by the St John's protocol had final diagnosis and DIF result recorded.
Results:
In the mHoVert group, significantly more diagnoses were certain/probable (66%, 95% confidence interval [CI]: 57%-75%), compared to 46% (95% CI: 36%-56%) of diagnoses in the St John's protocol group (p = 0.005). DIF result did not affect the final diagnosis in any of the 57 cases reviewed.
Conclusions:
DIF is not required in the diagnosis of most cases of alopecia. The mHoVert method provides more certain/probable diagnoses than the St John's protocol and can reduce cost and patient morbidity.
