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Two histopathologic patterns found in cutaneous lupus of the scalp

Histopathologic assessment of hair follicles in patients with chronic cutaneous lupus erythematosus of the scalp revealed two distinct patterns, according to recent findings.

The researchers suggested that morphologic changes to hair follicles in chronic cutaneous lupus erythematosus have not been sufficiently described. The current retrospective analysis included 33 transversely sectioned skin biopsy specimens accrued at a single center between April 2005 and March 2015.

The analysis yielded a number of novel findings, including basaloid follicular epithelium that lacked follicles at deeper levels, which were found in 55% of the specimens. Increased catagen/telogen hair follicles were reported in just under half of the specimens, while follicular miniaturization occurred in 46%, and pigment casts occurred in 19%. The researchers categorized these results as new findings, as well.

Overall, two histopathologic patterns emerged: an alopecia areatalike pattern and a lichen planopilarislike pattern, according to the results.

Inflammation in fibrous stelae and perieccrine inflammation were reported in just under half of the specimens. Deep perivascular inflammation and increased dermal mucin also were reported.

One-quarter of the specimens demonstrated aggregates of basaloid follicular epithelium at the lower follicle.

Most of the specimens lacked sebaceous glands, and most follicles showed interface change, perifollicular inflammation, and a thick basement membrane zone, according to the findings. Other common findings included vacuolar alteration and a thickened basement membrane zone at the dermoepidermal junction, while epidermal atrophy was rare.

“We hypothesize that the basaloid aggregates are remnants of hair follicles that are no longer actively cycling,” the researchers concluded. – by Rob Volansky

Disclosure: The researchers report no relevant financial disclosures.