Abstract
Introduction: Both scarring and non-scarring alopecias exist; however, rare cases demonstrate features of both classes. Case Report: We describe an interesting alopecia case with amalgamated clinical, histologic and immunopathologic features of scarring and non-scarring alopecia. Specifically, the case displays combined features of alopecia areata (AA) and of central centrifugal cicatricial alopecia (CCCA). A 36 year old female presented with symmetric, round, patchy hair loss on her scalp. Methods: Biopsies for hematoxylin and eosin (H&E) examination, as well as for special stains, direct immunofluorescence (DIF) and immunohistochemistry (IHC) were performed. Results: The H&E biopsy revealed focally diminished hair follicular units, and sebaceous gland damage. Perifollicular concentric fibrosis was confirmed by Verhoeff elastin special staining. Antibodies to micelles were noted. Positive IHC staining for CD4, CD8, CD45 and multiple proteases and protease inhibitors was noted around selected follicular unit remnants. Conclusion: We present a rare alopecia, combining histologic features of CCCA with additional, selected immunologic features of AA.
Highlights
Both scarring and non-scarring alopecias exist; rare cases demonstrate features of both classes
Examples include lupus erythematosus (LE) and lichen planus (LP) that may present with an overlap syndrome
Other examples that have been described of possible nosologic overlap include fibrosing alopecia in patterned distributions, and/or Graham-Little syndrome
Summary
Case Report A 36 year old African American female presented for alterations in her scalp hair She demonstrated symmetric, round patches of alopecia with some burning sensations. A Periodic acid Schiff(PAS) stain displayed positive enhancement along basement membrane zone areas of some hair follicular units and eccrine glands CD8 positive cells were noted within the perifollicular lymphocytic infiltrate, and around blood vessels that supplied piloerector muscles and eccrine glands (Fig. 1). There was strong positive staining with IgG and IgD around hair follicular units; IgD was accentuated around follicular remnants. Positive staining for IgG was noted in focal areas of the epidermal granular cell layer, within dermal endothelial-mesenchymal cell junctions, and in endothelial cells of perifollicular blood vessels. Positive IgD staining was noted within and around hair follicles, and around surrounding blood vessels.
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