Elastin staining patterns in primary cicatricial alopecia.

Abstract:

BACKGROUND:Most biopsy specimens of cicatricial (scarring) alopecia can be readily subclassified as lymphocytic versus neutrophilic, but specific diagnosis remains difficult, particularly when a late stage of the disease is sampled. OBJECTIVE:We sought to document patterns of scarring highlighted by elastic tissue staining in primary cicatricial alopecia. METHODS:We documented Verhoeff elastic van Gieson staining patterns in 58 routinely embedded (vertical) biopsy specimens of cicatricial alopecia. Patterns of fibrosis included perifollicular (wedge-shaped vs broad tree trunk-shaped) and diffuse. The patterns were compared against the diagnosis obtained by independent expert clinical review, including central centrifugal cicatricial alopecia (CCCA), lichen planopilaris, traction alopecia, frontal fibrosing alopecia, discoid lupus erythematosus, and tufted folliculitis. RESULTS:Wedge-shaped perifollicular fibrosis was seen in lichen planopilaris but also in CCCA. Broad tree trunk-shaped perifollicular fibrosis was most commonly encountered in CCCA. LIMITATIONS:The retrospective nature of the study precluded temporal staging of the disease process. CONCLUSIONS:Patterns of fibrosis highlighted by elastin staining in primary cicatricial alopecia appear to be disease specific. Superficial wedge-shaped perifollicular fibrosis is associated with but may not be specific for lichen planopilaris. Broad tree trunk-like perifollicular fibrosis is specific for CCCA but not present in many cases. Elastin staining represents a useful ancillary study for the evaluation of late-stage scarring alopecia in routinely oriented punch biopsy specimens.

journal_name

J Am Acad Dermatol

authors

Fung MA,Sharon VR,Ratnarathorn M,Konia TH,Barr KL,Mirmirani P

doi

10.1016/j.jaad.2013.07.018

subject

Has Abstract

pub_date

2013-11-01 00:00:00

pages

776-782

issue

5

eissn

0190-9622

issn

1097-6787

pii

S0190-9622(13)00770-6

journal_volume

69

pub_type

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