title: Distinguishing diffuse alopecia areata (AA) from pattern hair loss (PHL) using CD3(+) T cells.
abstract: BACKGROUND
  Distinguishing between diffuse subacute alopecia areata (AA), in which the peribulbar infiltrate is absent, and pattern hair loss is challenging, particularly in cases that lack marked follicular miniaturization and a marked catagen/telogen shift.
  
  
  OBJECTIVE
  We sought to distinguish diffuse AA from pattern hair loss using CD3(+) T lymphocytes.
  
  
  METHODS
  A total of 28 cases of subacute AA and 31 cases of pattern hair loss were selected and a 4-mm punch biopsy was performed. All the specimens were processed using the "HoVert" (horizontal and vertical) technique. In all cases, hematoxylin-eosin and immunohistochemical stains for CD3, CD4, CD8, and CD20 were performed.
  
  
  RESULTS
  The presence of CD3(+) lymphocytes within empty follicular fibrous tracts (stela), even without a concomitant peribulbar infiltrate, is a reliable histopathological clue in supporting a diagnosis of AA (sensitivity 0.964, specificity 1, P ≤ .001).
  
  
  CONCLUSIONS
  Limited tissue for analysis remained in the clinical sample tissue blocks.
  
  
  CONCLUSIONS
  The presence of CD3(+) T-cells within empty follicular fibrous tracts (stela) supports a diagnosis of AA.
authors: Departments of Dermatology and Dermatopathology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium. Electronic address: kolivras@gmail.com.
authors: Athanassios
authors: A
authors: Kolivras
authors: Departments of Biomedical Engineering, Pathology, and Dermatology, Oregon Health Sciences University, Portland, Oregon.
authors: Curtis
authors: C
authors: Thompson
mesh_terms: D000328:Adult; D000506:Alopecia Areata / Q000175:diagnosis / Q000276:immunology / Q000473:pathology*; D001707:Biopsy, Needle; D017252:CD3 Complex / Q000276:immunology*; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D018859:Hair Follicle / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D050378:T-Lymphocytes, Regulatory / Q000276:immunology*
chemical_list: D017252:CD3 Complex
keywords: CD3; alopecia areata; follicular fibrous tracts; pattern hair loss; stela