Elastin staining patterns in primary cicatricial alopecia

Maxwell A Fung, Victoria R. Sharon, Mondhipa Ratnarathorn, Thomas Konia, Keira L. Barr, Paradi Mirmirani

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


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. Limitations 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.

Original languageEnglish (US)
Pages (from-to)776-782
Number of pages7
JournalJournal of the American Academy of Dermatology
Issue number5
StatePublished - Nov 2013


  • cicatricial alopecia
  • dermatopathology
  • elastin
  • lichen planopilaris
  • scarring alopecia
  • traction alopecia

ASJC Scopus subject areas

  • Dermatology


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