Elston, Dirk M. MD

To the Editor:

I congratulate Charlotte LaSenna and Mariya Miteva for an outstanding article on special stains and immunohistochemistry in the evaluation of scalp biopsies.¹ They have a gift for lending clarity and perspective to a difficult topic. In their discussion of elastic stains, they cite a study by Roten et al² that showed a gradual increase in fine elastic fibers in scars beginning at approximately 3 months and peaking at 12 months. It should be noted that although these fine elastic fibers can be visualized with the Miller elastic stain, they are inapparent in elastic Van Gieson–stained sections of surgical scars up to 10 year old.³ It is also important to note that true scars result in recoil of elastic fibers in the adjacent dermis (Fig. 1), a feature that helps to distinguish genuine scarring from the delicate perifollicular elastic network noted in conditions like androgenetic (pattern) alopecia (Fig. 2).

Figure 1

Figure 2

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