A recent report suggests that elastic fibers appear in scars in a time-depe
ndent fashion. This observation prompted our investigation, because we have
found elastic tissue stains helpful in determining the pattern of scarring
in cases of permanent alopecia. We carried out this investigation to deter
mine if the Verhoeff-Van Gieson (VVG) elastic stain can reliably differenti
ate scarred from non-scarred dermis and to test our hypothesis that elastic
stained sections are helpful in distinguishing lichen planopilaris (LPP) f
rom lupus erythematosus (LE), central progressive alopecia in black females
("follicular degeneration syndrome" and "hot comb alopecia" are other term
s used to describe this condition) and classic ivory white idiopathic pseud
opelade. We studied histological sections from surgical scars of known dura
tion, stained with the VVG elastic stain and VVG-stained sections of scalp
biopsies from patients with established lesions of permanent alopecia. In m
ost cases, both vertical and transverse sections were examined. In every ca
se, the WG stain clearly differentiated scar from the normal surrounding de
rmis. Distinct patterns of elastic tissue allowed for correct classificatio
n in most of the well-established cases of permanent alopecia studied. We d
etermined that the Verhoeff-Van Gieson stain is an excellent stain to evalu
ate the pattern of scarring in cases of permanent alopecia and elastic tiss
ue stains may be helpful in the histological evaluation of alopecia.