Department of Dermatology, University of California, Davis, Sacramento, California; Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California.
Department of Dermatology, University of California, Davis, Sacramento, California.
J Am Acad Dermatol. 2013 Nov;69(5):776-782. doi: 10.1016/j.jaad.2013.07.018. Epub 2013 Sep 10.
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.
We sought to document patterns of scarring highlighted by elastic tissue staining in primary cicatricial alopecia.
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.
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.
The retrospective nature of the study precluded temporal staging of the disease process.
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.
大多数瘢痕性（瘢痕）脱发的活检标本可以很容易地分为淋巴细胞性和中性粒细胞性，但具体诊断仍然很困难，特别是在疾病晚期取样时。
我们试图记录原发性瘢痕性脱发中弹性组织染色突出的瘢痕模式。
我们记录了 58 例常规包埋（垂直）瘢痕性脱发活检标本的Verhoeff 弹性van Gieson 染色模式。纤维化模式包括毛囊周围（楔形与宽树干形）和弥漫性。将这些模式与独立专家临床评估获得的诊断进行比较，包括中心离心性瘢痕性脱发（CCCA）、扁平苔藓性瘢痕性脱发、牵引性脱发、额部纤维性脱发、盘状红斑狼疮和簇状滤泡炎。
毛囊周围楔形纤维化见于扁平苔藓性瘢痕性脱发，但也见于 CCCA。毛囊周围宽树干形纤维化最常见于 CCCA。
研究的回顾性性质排除了疾病过程的时间分期。
原发性瘢痕性脱发中弹性染色突出的纤维化模式似乎具有疾病特异性。浅层楔形毛囊周围纤维化与扁平苔藓性瘢痕性脱发相关，但可能不具有特异性。宽树干样毛囊周围纤维化是 CCCA 的特异性表现，但在许多病例中并不存在。弹性染色代表了一种有用的辅助研究方法，可用于评估常规打孔活检标本中晚期瘢痕性脱发。
