title: Elastin staining patterns in primary cicatricial alopecia.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, University of California, Davis, Sacramento, California; Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California. Electronic address: maxwell.fung@ucdmc.ucdavis.edu.
authors.forename: Maxwell A
authors.initials: MA
authors.lastname: Fung
authors.affiliation: Department of Dermatology, University of California, Davis, Sacramento, California.
authors.forename: Victoria R
authors.initials: VR
authors.lastname: Sharon
authors.affiliation: Department of Dermatology, University of California, Davis, Sacramento, California.
authors.forename: Mondhipa
authors.initials: M
authors.lastname: Ratnarathorn
authors.affiliation: Department of Dermatology, University of California, Davis, Sacramento, California; Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Konia
authors.affiliation: Department of Dermatology, University of California, Davis, Sacramento, California; Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California.
authors.forename: Keira L
authors.initials: KL
authors.lastname: Barr
authors.affiliation: Department of Dermatology, Kaiser Permanente Medical Group, Vallejo, California.
authors.forename: Paradi
authors.initials: P
authors.lastname: Mirmirani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000505:Alopecia / Q000473:pathology*; D004547:Elastic Tissue / Q000473:pathology*; D004549:Elastin / Q000032:analysis*; D005260:Female; D005355:Fibrosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012535:Scalp / Q000473:pathology*; D013194:Staining and Labeling
chemical_list: D004549:Elastin
keywords: CCCA; DLE; EVG; FFA; H&E; LPP; Verhoeff elastic van Gieson; central centrifugal cicatricial alopecia; cicatricial alopecia; dermatopathology; discoid lupus erythematosus; elastin; frontal fibrosing alopecia; hematoxylin-eosin; lichen planopilaris; scarring alopecia; traction alopecia