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Dermatopathology: Practical & Conceptual April - June 2009
3. Late stage alopecia: Differential diagnosis by types of fibrosis
Juliana Jung, M.D.
Almut Böer, M.D.
In dermatopathology, specimens taken from late lesions of inflammatory alopecias are often frustrating when no specific diagnosis seems possible based on the changes observed. In this study, examples of late lesions of various inflammatory alopecias are compared especially in regard to changes in the connective tissue that may help to identify a specific disease process.
Twenty-seven biopsy specimens taken from lesions of inflammatory types of alopecias (alopecia of lupus erythamatosus, lichen planopilaris, folliculitis decalvans, and alopecia areata) were examined. Sections showing late stages devoid of follicles were selected and studied for connective tissue changes in the papillary dermis, the adventitial dermis, and the reticular dermis.
Atrophy of the papillary dermis is seen in folliculitis decalvans and lupus erythematosus, but not in lichen planopilaris or alopecia areata. In the case of lupus erythematosus, it is accompanied by either vacuolar alteration in the basal layer or thickened basement membrane; in the case of folliculitis, it is accompanied by horizontal arrangement of collagen in the reticular dermis with increase in number of fibroblasts and plasma cells; whereas the reticular dermis is largely normal in all other types of inflammatory alopecias. Blue-gray remnants of glassy membrane in fibrous tracts indicate alopecia areata.
It is helpful for a dermatopathologist studying sections of alopecia to look between the follicles or what is residual of them. Identification of changes in the connective tissue in the papillary dermis and reticular dermis may facilitate a specific diagnosis.
Juliana Jung, M.D., is a pathologist at Hospital Erasto Gaertner, Curitiba, Brazil, and currently a fellow in dermatopathology at the Dermatologikum Hamburg, Germany, where Almut Böer, M.D. is a dermatopathologist. This article was reviewed by Becima Fazaa, M.D., and Ricardo Achenbach, M.D. Contact corresponding author via email:
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