Barbara Wilkinson

Postmenopausal frontal fibrosing alopecia : A frontal variant of lichen planopilaris

BACKGROUND Lichen planopilaris usually produces multifocal areas of scarring alopecia. Recently, a condition in postmenopausal women characterized by progressive frontal hairline recession associated with scarring has been described. OBJECTIVE Our purpose was to study the clinical and histopathologic features and results of treatment in a group of women with the frontal variant of lichen planopilaris and to compare the immunohistochemical profile of scalp biopsy specimens from this subset with that found in the multifocal variant of lichen planopilaris. METHOD The clinical data as well as the histopathologic findings in 16 women with frontal fibrosing alopecia were collated. The immunohistochemical profile of six scalp biopsy specimens from the frontal hairline were compared with six specimens from women with multifocal lichen planopilaris. RESULTS In addition to the progressive frontal fibrosing alopecia in all 16 women, total loss or a marked decrease of the eyebrows was observed in 13. No evidence of lichen planus was observed at other sites. In one patient multifocal areas of lichen planopilaris developed in the scalp. The frontal fibrosing alopecia was slowly progressive but has stabilized in five patients. Biopsy specimens from the frontal hairline showed histologic changes identical to lichen planopilaris. Immunophenotyping failed to reveal any significant differences between the frontal and multifocal variants. No effective treatments emerged although oral steroids and antimalarials may temporarily slow the course. Hormone replacement therapy did not appear to influence the course of the alopecia. CONCLUSION Progressive frontal fibrosing alopecia is a clinically distinct variant of lichen planopilaris that affects in particular elderly women and frequently involves the eyebrows. The basis for this lichenoid tissue reaction targeting frontal scalp follicles and eyebrows is unknown.

Procollagen 1 expression in atypical fibroxanthoma and other tumors.

Background:  Procollagen (PC) is secreted by fibroblasts into the extracellular matrix, where it is cleaved to form collagen. The rat anti‐human PC‐1 monoclonal antibody has been reported to react with atypical fibroxanthoma (AFX), a poorly differentiated but usually benign skin lesion common in elderly patients. We have studied PC‐1 staining in 50 tumors with AFX histological features (four of which were subsequently reclassified as non‐AFX tumors) to confirm this prior observation. In addition, we have investigated PC‐1 in other skin tumors, particularly those with spindled cell or sclerosing/desmoplastic morphologies.

Hypopigmented common blue nevus

Blue nevus is a benign pigmented lesion of dermal melanocytes with a number of histologic and clinical variants, of which the major types are the common blue nevus, cellular blue nevus and combined nevus.

Nucleolar organizer regions and image analysis nuclear morphometry of small cell (nevoid) melanoma

Small cell (nevoid) melanomas may provide difficulties in diagnosis as their constituent cell type resembles a benign nevoid melanocyte. In the present study, 10 small cell melanomas were analyzed for the silver staining of their nucleolar organizing regions (AgNORs), and their nuclear area and perimeter were measured by computerized digital image analysis and compared with 10 superficial spreading melanomas lacking small cell differentiation and 10 dermal nevi. The average number of AgNORs per nucleus was 5.83 (SD ± 1.69) for small cell melanomas and was significantly different when compared with 8.49 (SD ± 1.58) for superficial spreading melanomas (p<0.05) and 2.71 (SD ± 0.50) for dermal nevi (p<0.05). Digital image analysis confirmed that the nuclear perimeter and nuclear area of cells in nevoid melanomas did not significantly differ from those of ordinary dermal nevi (p>0.05), but both group were significantly different from superficial spreading melanomas lacking a small cell morphology (p<0.05). Counting AgNOR numbers may be useful in evaluating small cell (nevoid) melanomas and provides a technique for differentiating their constituent cell from ordinary nevus cells. Nuclear morphometry determined by digital image analysis may help better define the nuclear size in small cell melanomas.

Small cell (naevoid) melanoma: A clinicopathologic study of 131 cases

One hundred and thirty-one small cell melanomas were reviewed with respect to clinical data submitted with each specimen and the histological pattern of each tumour. Of the small cell melanomas, 80% developed in individuals over the age of 50 years. There was a 2:1 male predominance with 58% of the tumours in men occurring on the back. All but one melanoma showed a lentiginous intraepidermal pattern. The dermal component was characterized by cords and nests of hyperchromatic melanocytes associated with interstitial fibrosis. Small cell melanomas may be recognized as thin lesions and are commonly located in chronic sun-damaged skin of elderly individuals. They may represent a special naevoid variant of lentigo maligna melanoma.

Lipid and giant cell poor necrobiotic xanthogranuloma

An 88‐year‐old man over a 7‐month period developed multiple yellow firm focally ulcerative papules and nodules over his face, neck and forearms. Seven skin biopsies showed a diffuse infiltrate of epithelioid histiocytes associated with areas of necrosis with neutrophilia. Two biopsies showed xanthogranulomatous foci, but cholesterol clefts, prominent giant cells or lymphoid aggregates were not evident. Necrosis with leukocytoclastic debris overshadowed the presence of hyaline necrobiosis. Ultrastructural examination and oil red‐o stains on frozen sections revealed focal lipid vacuoles within histiocytes. A paraprotein was detected in the patients serum. This presentation may represent a lipid and giant cell poor variant of necrobiotic xanthogranuloma (NXG) and may potentially lead to a delay in diagnosis.

Quantification of hair follicle parameters using computer image analysis: A comparison of androgenetic alopecia with normal scalp biopsies

Computer image analysis enables large numbers of hairs to be measured in an automated fashion. In this study, we examined horizontal scalp biopsies from 10 patients with a histological diagnosis of androgenetic alopecia and 10 normal control subjects. The density of hair follicles and the ratio of terminal to vellus hairs were determined. Hair shaft, hair canal and hair follicle diameter, inner root sheath width and outer root sheath area were measured using the Chromatic Colour Image Analysis program. This study showed a statistically significant progressive decrease in size of hair canal diameters from normal terminal hairs (85.93 ± 10.07 μm) through to androgenetic alopecia terminal (68.83 ± 13.60 μm) and vellus hairs (28.67 ± 5.60 μm). This pattern is also seen with hair follicle diameters; normal terminal (268.41 ± 24.88 μm), androgenetic alopecia terminal (236.34 ± 17.23 μm), and vellus hairs (130.88 ± 19.96 μm). Outer root sheath areas, hair shaft diameters and ratio of terminal to vellus hairs were significantly larger in normal (18500 ± 4222 μm2; 82.71 ± 13.79 μm; 36:1; respectively) compared with androgenetic alopecia scalp biopsies (8403 ± 3322 μm2; 61.11 ± 14.42 μm; 3:1; respectively), whereas inner root sheath width and density did not vary significantly. Computer image analysis can be adapted for use in clinical trials where large numbers and objectivity are critical in determining the efficacy of hair growth promoters.

Mast cell quantitation by image analysis in adult mastocytosis and inflammatory skin disorders

Mast cell numbers were quantitated in adult cases of mastocytosis demonstrating non‐diffuse perivascular and upper dermal concentrations of mast cells. Using the Leder stain and computerised video image analysis, a mean of 382 (± 28 SE) mast cell per mm2 were counted in the superficial dermis in skin biopsies from 30 adult cases of mastocytosis, in contrast to a mean of 43 (± 5 SE) mast cells per mm2 in skin biopsies from 50 inflammatory dermatoses represented by subacute dermatitis, pigmented purpuric dermatosis, erythema multiforme, lichen planus and granuloma annulare. Ten skin biopsies showing no significant inflammation had a mean of 54 (± 7 SE) mast cells per mm2 in the upper dermis. The mean area of individual mast cells as assessed by image analysis in the mastocytosis group was 47.40 um2 (± 2.26 um2, SE) which was significantly different (P < 0.01) than the mast cell area (32.34 μm2± 2.22 μm2, SE) in all other groups combined. Computerised video image analysis represents an alternative technique which is useful in assessing mast cell numbers and particularly mast cell size in adult cases of macular mastocytosis and in other dermatoses.

Neural spectrum: palisaded encapsulated neuroma and verocay body poor dermal schwannoma.

We examined 25 palisaded encapsulated neuromas (PEN) of the skin and used peripherin antibody as an immunohistochemical label for axons. Quantitative analysis of the axon to schwann cell nuclear ratio for each PEN was determined by examining cross‐sectioned neuroid fascicles. This revealed that 120 of the 253 cross‐sectioned fascicles in PEN lacked axon and only 5% of the fascicles had an axon to schwann cell nuclear ratio greater than 1:2. In contrast, all fascicles in 40 dermal nerves adjacent to PENs as well as 35 traumatic neuromas in surgical scars had an axon to schwann cell nuclear ratio of at least 1:2 and die majority a ratio of 1:1 or higher. These results suggest that there is a spectrum between PENs which arc axon rich to a form of schwannoma with an identical histopathology which lacks significant axonal content and that not all PENs are true neuromas.

A comparative immunohistochemical study of lichen planus and discoid lupus erythematosus

A comparative immunohistochemical study was performed on skin biopsies from 10 patients with lichen planus and 10 patients with discoid lupus erythematosus (DLE). A panel of antibodies against T lymphocytes (UCHL‐1, OPD‐4, CD8, CD45), B lymphocytes (L‐26), granulocytes (Leu‐M1), activation markers (Ki‐1, LN‐3), macrophages, fibroblasts and dendritic cells (FXIIIa, S‐100, Mac‐387, K.P‐1, vimentin), endothelial cells (CD34), and epithelial cells (epithelial membrane antigen) was employed using a peroxidase‐anti‐peroxidase technique. The recently released CD8 antiserum required microwave antigen retrieval of formalin‐fixed, paraffin‐embedded tissue to label lymphocytes. The results showed many similarities in the lymphocyte subsets and macrophages between lichen planus and discoid lupus erythematosus. The most important differences between the two conditions were statistically significant increases in the number of S‐100+ cells in the epidermis and dermis, FXIIIa+ cells in the dermis and CD34+ vessels within the inflammatory infiltrate in lichen planus.