St John Protocol Not Necessary For Diagnosing Most Cases of Alopecia

According to a study published in the Journal of Cutaneous Pathology, the 2-biopsy technique with direct immunofluorescence (DIF), otherwise known as the St John Protocol, is not necessary for diagnosing most cases of alopecia.

Researchers aimed to evaluate the diagnostic certainty of the modified HoVert (mHoVert) method compared with the St John protocol. They reviewed 57 cases of alopecia processed using the St John protocol and 60 cases processed using the mHoVert method. Histopathology reports were analyzed, and diagnoses were categorized as certain/probable, possible, or uncertain. Cases processed using the St John protocol had their final diagnosis and DIF results recorded.

Results showed that the mHoVert group exhibited significantly more certain/probable diagnoses (66%, 95% CI: 57%-75%) compared with the St John protocol group (46%, 95% CI: 36%-56%) (P = .005). Interestingly, the DIF result did not impact the final diagnosis in any of the reviewed cases.

“The mHoVert method provides more certain/probable diagnoses than the St John protocol and can reduce cost and patient morbidity,” the authors concluded.

Reference
Adams L, Amphlett A, Gardette E, Deroide F, Jones J. The modified HoVert (mHoVert) method improves diagnostic certainty compared to the St John's protocol for alopecia biopsy specimens: a retrospective single center study. J Cutan Pathol. Published online May 19, 2023. doi:10.1111/cup.14447