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Elastic tissue staining, fluorescent microscopy displayed similar pattern in alopecia biopsy

Elastic tissue staining was the most reliable way to determine scarring pattern in alopecia biopsy specimens, with fluorescent microscopy displaying an identical pattern in most cases, according to study results.

Dirk. M. Elston, MD, of the Ackerman Academy of Dermatopathology, New York, and colleagues sought to determine the validity of polarized microscopy relative to elastic tissue staining and fluorescent microscopy. They evaluated elastic tissue patterns in 60 alopecia specimens in elastic van Gieson (EVG)-stained sections. Comparable hematoxylin-eosin sections were examined by fluorescent microscope, while polarized microscopy assessed birefringence pattern.

 

Dirk M. Elston

High sensitivity (1.0; 95% CI, 0.85-1) and specificity (1.0; 95% CI, 0.86-1) were demonstrated with EVG staining to identify nonscarring alopecia. Fluorescent microscopy displayed identical results in pattern of elastic tissue (sensitivity, 1.0; 95% CI, 0.84-1; specificity, 1.0; 95% CI, 0.85-1) in 54 cases. Intensity of eosin fluorescence prevented assessment of the other six specimens (three nonscarring and three scarring) for elastic tissue pattern, which researchers said might be a source of study bias.

“Strong birefringence in dermal collagen sparing fibrous tracts had high specificity [1.0; 95% CI, 0.86-1], but lower sensitivity [0.59; 95% CI, 0.39-0.76],” the researchers wrote.

Six patients with central centrifugal cicatricial alopecia had a pattern of birefringence in dermal collagen and broad fibrous tracts.

“Although a pattern of collagen birefringence on polarized microscopy distinctly sparing fibrous tract is specific for nonscarring alopecia, not all cases of nonscarring alopecia demonstrate this pattern,” the researcher concluded. “Strong collagen birefringence within both the dermis and fibrous tracts suggests a diagnosis of central centrifugal cicatricial alopecia.

“Polarized microscopy and fluorescent microscopy have the advantage of immediacy and low cost, but must be interpreted carefully and may not be a substitute for elastic tissue staining.”

Disclosure: The researchers report no relevant financial disclosures.