Elastic staining versus fluorescent and polarized microscopy in the diagnosis of alopecia

Elastic tissue staining is the most reliable means to determine the pattern of scarring in alopecia biopsy specimens. In most cases, fluorescent microscopy of hematoxylin-eosin sections shows an identical pattern. Although a pattern of collagen birefringence on polarized microscopy distinctly sparing fibrous tract is specific for nonscarring alopecia, not all cases of nonscarring alopecia demonstrate this pattern. Strong collagen birefringence within both the dermis and fibrous tracts suggests a diagnosis of central centrifugal cicatricial alopecia.