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Dilation of Multiple Eccrine Ducts as a Highly Specific Marker for Cicatricial Alopecia.
Am J Dermatopathol. 2019 Dec; 41(12):871-878.AJ

Abstract

BACKGROUND

Eccrine duct dilation (EDD) was recently described to occur more frequently in cicatricial alopecias than noncicatricial alopecias. Because single EDD can be useful in the evaluation of alopecias, we aimed to determine whether dilation of multiple eccrine duct units, or "multiple eccrine duct dilation (MEDD)," could more specifically discriminate between cicatricial and noncicatricial alopecias.

METHODS

We retrospectively evaluated 611 scalp biopsies (342 cicatricial alopecias and 269 noncicatricial alopecias).

RESULTS

Among cicatricial alopecias, MEDD was found in 21% (25/118) of central centrifugal cicatricial alopecia, 26% (29/109) of lichen planopilaris, 13% (10/73) of discoid lupus erythematosus, 31% (5/16) of acne keloidalis nuchae, and 26% (7/26) of folliculitis decalvans. In noncicatricial alopecias, MEDD was found in 1% (1/102) of androgenetic alopecia, 0.7% (1/150) of alopecia areata, and 0% (0/17) of telogen effluvium. In cicatricial alopecias, MEDD occurred in a significantly higher frequency (22%; 76/342) compared with noncicatricial alopecias (0.7%; 2/269) (P-value <0.0001). The presence of MEDD correlated with a diagnosis of cicatricial alopecia with 22% sensitivity and 99% specificity. MEDD also occurred more frequently in cases with moderate to severe inflammation and fibroplasia, suggesting that EDD is a reactive change secondary to the scarring processes.

CONCLUSION

The presence of MEDD on scalp biopsies may be a highly specific marker of cicatricial alopecia and can aid in rendering a more accurate diagnosis. MEDD without other definitive histopathologic features of cicatricial alopecia may compel pathologists to pursue additional workup and/or raise the possibility that a cicatricial alopecia cannot be entirely excluded.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Tan TL
Dermatopathology Fellow, Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Doytcheva K
Clinical Research Fellow, Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Guitart J
Professor, Chief of Dermatopathology, Department of Dermatology, Robert H. Lurie Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL.
Gerami P
Professor, Department of Dermatology, Robert H. Lurie Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL.
Yazdan P
Assistant Professor, Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL.

MeSH

AlopeciaBiopsyCicatrixDatabases, FactualDiagnosis, DifferentialDilatation, PathologicEccrine GlandsHumansPredictive Value of TestsRetrospective StudiesScalpScalp Dermatoses

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31764231

Citation

Tan, Timothy L., et al. "Dilation of Multiple Eccrine Ducts as a Highly Specific Marker for Cicatricial Alopecia." The American Journal of Dermatopathology, vol. 41, no. 12, 2019, pp. 871-878.
Tan TL, Doytcheva K, Guitart J, et al. Dilation of Multiple Eccrine Ducts as a Highly Specific Marker for Cicatricial Alopecia. Am J Dermatopathol. 2019;41(12):871-878.
Tan, T. L., Doytcheva, K., Guitart, J., Gerami, P., & Yazdan, P. (2019). Dilation of Multiple Eccrine Ducts as a Highly Specific Marker for Cicatricial Alopecia. The American Journal of Dermatopathology, 41(12), 871-878. https://doi.org/10.1097/DAD.0000000000001396
Tan TL, et al. Dilation of Multiple Eccrine Ducts as a Highly Specific Marker for Cicatricial Alopecia. Am J Dermatopathol. 2019;41(12):871-878. PubMed PMID: 31764231.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dilation of Multiple Eccrine Ducts as a Highly Specific Marker for Cicatricial Alopecia. AU - Tan,Timothy L, AU - Doytcheva,Kristina, AU - Guitart,Joan, AU - Gerami,Pedram, AU - Yazdan,Pedram, PY - 2019/11/26/entrez PY - 2019/11/26/pubmed PY - 2020/4/15/medline SP - 871 EP - 878 JF - The American Journal of dermatopathology JO - Am J Dermatopathol VL - 41 IS - 12 N2 - BACKGROUND: Eccrine duct dilation (EDD) was recently described to occur more frequently in cicatricial alopecias than noncicatricial alopecias. Because single EDD can be useful in the evaluation of alopecias, we aimed to determine whether dilation of multiple eccrine duct units, or "multiple eccrine duct dilation (MEDD)," could more specifically discriminate between cicatricial and noncicatricial alopecias. METHODS: We retrospectively evaluated 611 scalp biopsies (342 cicatricial alopecias and 269 noncicatricial alopecias). RESULTS: Among cicatricial alopecias, MEDD was found in 21% (25/118) of central centrifugal cicatricial alopecia, 26% (29/109) of lichen planopilaris, 13% (10/73) of discoid lupus erythematosus, 31% (5/16) of acne keloidalis nuchae, and 26% (7/26) of folliculitis decalvans. In noncicatricial alopecias, MEDD was found in 1% (1/102) of androgenetic alopecia, 0.7% (1/150) of alopecia areata, and 0% (0/17) of telogen effluvium. In cicatricial alopecias, MEDD occurred in a significantly higher frequency (22%; 76/342) compared with noncicatricial alopecias (0.7%; 2/269) (P-value <0.0001). The presence of MEDD correlated with a diagnosis of cicatricial alopecia with 22% sensitivity and 99% specificity. MEDD also occurred more frequently in cases with moderate to severe inflammation and fibroplasia, suggesting that EDD is a reactive change secondary to the scarring processes. CONCLUSION: The presence of MEDD on scalp biopsies may be a highly specific marker of cicatricial alopecia and can aid in rendering a more accurate diagnosis. MEDD without other definitive histopathologic features of cicatricial alopecia may compel pathologists to pursue additional workup and/or raise the possibility that a cicatricial alopecia cannot be entirely excluded. SN - 1533-0311 UR - https://www.unboundmedicine.com/medline/citation/31764231/Dilation_of_Multiple_Eccrine_Ducts_as_a_Highly_Specific_Marker_for_Cicatricial_Alopecia_ DB - PRIME DP - Unbound Medicine ER -