Evaluation of Elastic Fibers Pattern with Orcein Staining in Differential Diagnosis of Lichen Planopilaris and Discoid Lupus Erythematosus

  • Zahra Farzaneh Asadi Kani Department of Dermatopathology, Skin Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran.
  • Soheila Nasiri Mail Department of Dermatopathology, Skin Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran.
  • Rana Rafiei Department of Dermatopathology, Skin Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran.
  • Shima Younespour Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Keywords:
Lichen planopilaris, Discoid lupus erythematosus, Elastic fibers, Orcein staining

Abstract

Differential diagnosis of lichen planopilaris and discoid lupus erythematosus especially in late stages is a problem for clinicians and pathologists. Our aim was to find discriminator histopathologic findings that help us to achieve definite diagnosis without using immunofluorescence study. The histopathologic findings in 77 cases of lichen planopilaris were compared with those of 26 cases of discoid lupus erythematosus with Hematoxylin & Eosin and especially staining (Alcian blue pH 2.5, Periodic Acid Shiff, Orcein). Final histopathologic diagnosis was based on histologic findings, clinicopathological correlation, past medical history and immunofluorescence studies if were applied before. Then elastic fibers pattern in dermis and follicular sheath with orcein staining were described without having information about final diagnosis. New and subtle presentations of histologic changes were assessed. We compared all histopathologic finding for each staining method. Some histologic changes such as hypergranulosis, epidermal atrophy, mucin deposition, diffuse scar and some other patterns were not specific for any diagnosis. A setting of histopathologic findings and clinicopathological correlation were needed for accurate diagnosis. We had only one specimen for the vertical section, and we had no horizontal sections. Description of elastic fibers pattern in orcein staining may be helpful in achieving a specific diagnosis, but this is not completely reliable, and we had overlap features. Finally, immunofluorescence study may be recommended for suspicious cases.

References

Annessi G, Lombardo G, Gobello T, et al. A clinicopathologic study of scarring alopecia due to lichen planus:comparison with scarring alopecia in discoid lupus erythematosus and pseudopelade. J Am Dermatopathol 1999;21(4):324-31.

Templeton SF, Solomon AR. Scarring alopecia:a classification based on microscopic criteria. J Cutan Pathol 1994;21(2):97-109.

Elston DM, McCollough ML, Warschaw KE, et al. Elastic tissue in scars and alopecia. J Cutan Pathol 2000;27(3):147-52.

Pinkus H. Differential patterns of elastic fibers in scarring and non-scarring alopecia. J Cutan Pathol 1978;5(3):93-104.

Olsen EA, Bergfeld WF, Cotsarelis G, et al. Summary of North American Hair Research Society (NAHRS)- sponsored Workshop on Cicatricial Alopecia, Duke University Medical Center, February 10 and 11, 2001. JAm Acad Dermatol 2003;48(1):103-10.

Tandon YK, Somani N, Cevasco NC, et al. A histologicreview of 27 patients with lichen planopilaris. J Am Acad Dermatol 2008;59(1):91-8.

Moure ER, Romiti R, Machado MC, et al. Primary cicatricial alopecias:a review of histopathologic findings in 38 patients from a clinical university hospital in Sao Paulo, Brazil. Clinics (Sao Paulo) 2008;63(6):747-52.

Mehregan DA, Van Hale HM, Muller SA. Lichen planopilaris:clinical and pathologic study of forty-five patients. J Am Acad Dermatol 1992;27(6 Pt 1):935-42.

Ross EK, Tan E, Shapiro J. Update on primary cicatricial alopecias. J Am Acad Dermatol 2005;53(1):1-37.

Amato L, Mei S, Massi D, et al. Cicatricial alopecia;a dermatopathologic and immunopathologic study of 33 patients (pseudopelade of Brocq is not a specific clinicopathologic entity). Int J Dermatol 2002;41(1):8-15.

Fabbri P, Amato L, Chiarini C, et al. Scarring alopecia in discoid lupus erythematosus:a clinical, histopathologic and immunopathologic study. Lupus 2004;13(6):455-62.

Patel N, Mohammadi A, Rhatigan R. A comparativeanalysis of mast cell quantification in five common dermatoses:lichen simplex chronicus, psoriasis, lichen planus, lupus, and insect bite/allergic contact dermatitis/nummular dermatitis. ISRN Dermatol 2012;2012:759630-5.

Sharma R, Sircar K, Singh S, et al. Role of mast cells in pathogenesis of oral lichen planus. J Oral Maxillofac Pathol 2011;15(3):267-71.

Xu X, Solky B, Elenitsas R, et al. Scarring alopecia associated with mastocytosis. J Cutan Pathol2003;30(9):561-5.

Akin C, Metcalfe DD. Mastocytosis. In: Leung DYM,Greaves MW, editors. Allergic Skin Disease:A Multidisciplinary Approach. 1st ed. New York: CRC Press; 2000: p. 337-52.

Gillitzer R, Goebeler M. Chemokines in cutaneous wound healing. J Leukocyte Biol 2001;69(4):513-21.

How to Cite
1.
Farzaneh Asadi Kani Z, Nasiri S, Rafiei R, Younespour S. Evaluation of Elastic Fibers Pattern with Orcein Staining in Differential Diagnosis of Lichen Planopilaris and Discoid Lupus Erythematosus. Acta Med Iran. 52(3):220-227.
QRcode
Section
Articles