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Elastin staining patterns in primary cicatricial alopecia
Maxwell A Fung1, Victoria R Sharon2, Mondhipa Ratnarathorn2
1Department of Dermatology, University of California, Davis, Sacramento, California; Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California.
Journal of the American Academy of Dermatology
|September 17, 2013
Summary
Elastic tissue staining reveals distinct fibrosis patterns in scarring alopecia. Broad tree trunk-shaped fibrosis is specific for central centrifugal cicatricial alopecia (CCCA), aiding diagnosis in difficult cases.
Area of Science:
- Dermatopathology
- Histopathology
- Hair Biology
Background:
- Diagnosing cicatricial (scarring) alopecia via biopsy can be challenging, especially in late disease stages.
- Distinguishing between lymphocytic and neutrophilic patterns is often insufficient for specific diagnosis.
Purpose of the Study:
- To identify and document specific patterns of scarring in primary cicatricial alopecia using elastic tissue staining.
- To correlate these fibrosis patterns with specific diagnoses of cicatricial alopecia.
Main Methods:
- Elastic tissue (Verhoeff van Gieson) staining was performed on 58 vertical biopsy specimens of cicatricial alopecia.
- Fibrosis patterns (perifollicular: wedge-shaped vs. broad tree trunk-shaped; diffuse) were analyzed.
- Staining patterns were compared with expert clinical diagnoses, including central centrifugal cicatricial alopecia (CCCA), lichen planopilaris, and others.
Main Results:
- Wedge-shaped perifollicular fibrosis was observed in lichen planopilaris and CCCA.
- Broad tree trunk-shaped perifollicular fibrosis was predominantly identified in CCCA.
- The study noted limitations due to its retrospective nature, precluding disease staging.
Conclusions:
- Fibrosis patterns visualized by elastin staining appear disease-specific in primary cicatricial alopecia.
- Broad tree trunk-like perifollicular fibrosis is a specific indicator for CCCA.
- Elastin staining is a valuable ancillary tool for evaluating late-stage scarring alopecia in routine biopsy specimens.
