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Pseudopelade
Pseudopelade (of Brocq) is also known as alopecia cicatrisata.
It is a very rare condition primarily affecting women and sometimes
children. Initially well defined patches of hair loss develop which
for some people may deteriorate to near total scalp hair loss with
individual surviving hairs. The history of the condition for affected
individuals is usually slow lasting many years and for every male
affected three females get pseudopelade.
This is a poorly defined condition and frequently it is confused
with hair loss caused by lichen planopilaris or lupus erythematosus.
Indeed some dermatologists claim that lichen planopilaris and pseudopelade
are one and the same condition. Diagnosis of pseudopelade can be
quite difficult, but some basic clinical pointers dermatologists
look for include irregular shaped and confluent patches of alopecia
and in the early, actively progressing stage of the disease there
may be mild scalp inflammation (erythema).
A skin biopsy can help significantly in the diagnosis of pseudopelade
although there are no absolute histological diagnostic markers.
Typically, biopsies of pseudopelade affected skin show limited or
no inflammation. Inflammation is most frequently observed at the
edges of bald patches in the early stages of actively progressing
hair loss, however inflammation may not always be present especially
as the condition reaches a mature late stage. Scar tissue formation
and follicular plugging is comparatively limited. There may be a
reduced number or complete absence of sebaceous glands in affected
skin and the epidermis my look quite normal. All that remains of
the destroyed hair follicles are fibrous tissue streamers.
It is not understood how or why pseudopelade occurs, although some
dermatologists suspect it is another autoimmune based form of hair
loss. Alopecia areata is widely regarded as an autoimmune based
mechanism of hair loss. However, pseudopelade is not the same as
alopecia areata as the inflammation is typically around the upper
hair follicle whereas the inflammation in alopecia areata is primarily
around the lower hair follicle bulb region. In addition, while alopecia
areata can persist indefinitely, pseudopelade progresses, sometimes
over several years, and then stops. The result is patches of hair
loss where the hair follicles are generally destroyed. The inflammation
in the skin subsides at the same time the hair loss stops.
Transplantation of hair is used as a treatment for pseudopelade
but it is important to ensure that the condition has completed its
full course. Most dermatologists look for the hair loss lesion to
remain stable for at least 6 months before considering transplantation.
Because pseudopelade can involve inflammation and scarring, it is
unlikely that a hair transplant would last very long when the hair
loss is actively advancing. As you might suspect, the transplanted
hair follicles could also come under attack and be destroyed. So
it is important to ensure that the pseudopelade has stopped progressing
before attempting transplantation. When pseudopelade is active,
the only treatment available is use of corticosteroids against the
inflammation. Corticosteroids can help when there inflammation is
involved but when there is little or no inflammation the corticosteroids
have little positive effect.
Pseudopelade
references
- Braun-Falco
O, Imai S, Schmoeckel C, Steger O, Bergner T. Pseudopelade of
Brocq. Dermatologica. 1986;172(1):18-23.
- Braun-Falco
O, Bergner T, Heilgemeir GP. [The Brocq pseudopelade--a disease
picture or disease entity]. Hautarzt. 1989 Feb;40(2):77-83.
- Silvers
DN, Katz BE, Young AW. Pseudopelade of Brocq is lichen planopilaris:
report of four cases that support this nosology. Cutis. 1993 Feb;51(2):99-105.
- Sahl WJ.
Pseudopelade: an inherited alopecia. Int J Dermatol. 1996 Oct;35(10):715-9.
- Pierard-Franchimont
C, Pierard GE. Massive lymphocyte-mediated apoptosis during the
early stage of pseudopelade. Dermatologica. 1986;172(5):254-7.
- Annessi
G, Lombardo G, Gobello T, Puddu P. A clinicopathologic study of
scarring alopecia due to lichen planus: comparison with scarring
alopecia in discoid lupus erythematosus and pseudopelade. Am J
Dermatopathol. 1999 Aug;21(4):324-31.
- Headington
JT, Astle N. Familial focal alopecia. A new disorder of hair growth
clinically resembling pseudopelade. Arch Dermatol. 1987 Feb;123(2):234-7.
- Madani S, Trotter MJ, Shapiro J. Pseudopelade
of Brocq in beard area. J Am Acad Dermatol. 2000 May;42(5 Pt
2):895-6.
- Schwarzenbach R, Djawari D. [Pseudopelade
Brocq--possible sequela of stage III borrelia infection]? Hautarzt.
1998 Nov;49(11):835-7.
- Templeton SF, Solomon AR. Scarring alopecia:
a classification based on microscopic criteria. J Cutan Pathol.
1994 Apr;21(2):97-109.
- Collier PM, James MP. Pseudopelade of
Brocq occurring in two brothers in childhood. Clin Exp Dermatol.
1994 Jan;19(1):61-4.
- Vaughan Jones SA, Black MM. Cicatricial
alopecia occurring in two sisters from Ghana. Clin Exp Dermatol.
1994 Nov;19(6):500-2.
- Nayar M, Schomberg K, Dawber RP, Millard
PR. A clinicopathological study of scarring alopecia. Br J Dermatol.
1993 May;128(5):533-6.
- Dawber R. What is pseudopelade? Clin
Exp Dermatol. 1992 Sep;17(5):305-6.
- Pincelli C, Girolomoni G, Benassi L.
Pseudopelade of Brocq: an immunologically mediated disease?
Dermatologica. 1987;174(1):49-50.
- Jordon RE. Subtle clues to diagnosis
by immunopathology. Scarring alopecia. Am J Dermatopathol. 1980
Summer;2(2):157-9.
- Stough DB 3d, Berger RA, Orentreich N.
Surgical improvement of cicatricial alopecia of diverse etiology.
Arch Dermatol. 1968 Mar;97(3):331-4.
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