Elastin staining patterns in primary cicatricial alopecia

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...

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Bibliographic Details
Published in:Journal of the American Academy of Dermatology 2013-11, Vol.69 (5), p.776-782
Main Authors: Fung, Maxwell A., MD, Sharon, Victoria R., MD, Ratnarathorn, Mondhipa, MD, Konia, Thomas H., MD, Barr, Keira L., MD, Mirmirani, Paradi, MD
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Alopecia - pathology
cicatricial alopecia
Dermatology
dermatopathology
Elastic Tissue - pathology
elastin
Elastin - analysis
Female
Fibrosis
Humans
lichen planopilaris
Male
Middle Aged
Retrospective Studies
Scalp - pathology
scarring alopecia
Staining and Labeling
traction alopecia
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Summary: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.
ISSN:0190-9622
1097-6787
DOI:10.1016/j.jaad.2013.07.018