A study of histopathology and CD3 immunohistochemistry in alopecia aerate

Title : A study of histopathology and CD3 immunohistochemistry in alopecia aerate

Abstract:

Diagnosis of alopecia areata (AA) can be challenging when clinical presentation is not classical. One of the earliest and most important histopathological feature which we expect to see is the peribulbar lymphocytic infiltrate  however it may not be appreciable in many cases.  To demonstrate the utility of CD3 immunohistochemistry in diagnosis of alopecia areata. A 3mm punch biopsy from margin of alopecic patch was done in 87 patients with clinically diagnosed alopecia areata. The gross biopsy specimens were then cut to remove excess fat of subcutaneous tissue till the hair bulbs were visible. The biopsy was then processed to get a horizontal section at the level of bulb and stained with Hematoxilin and Eosin ( H & E ) and CD3 immunohistochemistry was performed.  Sections obtained  were examined  by two blinded observers for presence of appreciable peribulbar infiltrate. Association was found out between histopathology with Hematoxilin and Eosin and CD3 immunohistochemistry by using appropriate statistical test.  Out of 87 patients 25 had diffuse type of AA and 62 had patchy type. Out of 62 cases of patchy AA 22 were CD3⁺  and among these CD3⁺ cases 14  (63.6%) did not show appreciable peribulbar infiltrate on H & E. This difference was statistically significant with p value < 0.05. Among all  25 cases of clinically suspected diffuse alopecia areata , 5 (20%) were CD3 positive and none showed appreciable peribulbar infiltrate on H & E. Out of total 87 patients enrolled in the study 19 patients  that is 70.4% patients which were CD3⁺ failed to show appreciable infiltrate on H & E. This difference was statistically significant with p value < 0.05. This study demonstrates that in 54 out of total 87 patients  (87.1%) of clinically diagnosed alopecia areata, peribulbar infiltrate was not apparent in routine H & E staining. Around 70% of cases showed CD3 positivity but failed to show appreciable infiltrate on H & E. Immunohistochemistry has an edge over  H & E staining in detection of lymphocytic infiltrate in AA.

Biography:

She is the professor and head of Department of Dermatology at LTMMC and Sion hospital, Mumbai. She was the only female dermatologist who became a member in International Advisory Committee for 6th Congress For Hair Research in 2010, Cairns Australia. She is member of International society of Dermatology, American Academy of Dermatology, international dermoscopy society and Member of Asia – Pacific centre for aging skin (APCAS), for Proctor & Gamble Ltd Australia. She is a scientific advisor to Scientific  Folica Bio,USA and Faculty for F1000- post peer publication review  for trichology. She has received Systopic oration award at international congress of dermatology, Delhi, Dec 2013 for microneedling for hair stimulation and Dr Marquis oration at Cuticon Nov 2018, Nagpur.She has received International Scholarships at AAD 2018 and WCD 2019. She has been the Chairperson and organising secretory in the hair conference - Trichology Update 2015, 2016, 2017, 2018.