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Elastin staining patterns in cicatricial alopecia displayed disease specificity

Elastin staining in primary cicatricial alopecia highlighted patterns of fibrosis that appeared to be disease specific, according to recent study results.

To document patterns of scarring highlighted by elastic tissue staining in primary cicatricial alopecia, researchers identified 90 biopsy specimens from 2003 through 2010. Upon clinical review, 60 specimens from 55 patients (mean age, 55 years) were diagnosed. Verhoeff elastic van Gieson staining patterns were documented in 58 specimens. Loss of elastin on EVG-stained sections was used to demonstrate perifollicular and diffuse patterns of fibrosis, with perifollicular patterns subclassified as wedge-shaped or broad tree-trunk shaped.

Central centrifugal cicatricial alopecia (CCCA) was the most common diagnosis (20 patients), followed by lichen planopilaris (LPP; 11 patients), traction alopecia (11 patients), frontal fibrosing alopecia (six patients), discoid lupus erythematosus (four patients) and tufted folliculitis (one patient).

Broad tree-trunk shaped patterns of perifollicular fibrosis were most commonly encountered in CCCA (25%), while wedge-shaped patterns were observed in LLP (54%) and CCCA (55%).

“Superficial wedge-shaped perifollicular fibrosis is associated with but may not be specific for lichen planopilaris,” the researchers concluded. “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.”

Disclosure: The researchers report no relevant financial disclosures.