Pseudopelade: Symptoms, Diagnosis and Treatment RichFeel

Pseudopelade of Brocq is a relatively uncommon scalp condition. It progresses slowly and is a chronic disorder characterized by scarring hair loss. Pseudopelade can affect adults as well as children; however it is seen more commonly in middle aged and older women. The term Pseudopelade of Brocq was first used in 1888 by the French dermatologist Louis Anne Jean Brocq. In most cases the condition resolves on its own, however some treatment for symptomatic relief is recommended. This article explains the clinical features, diagnosis and treatment of Pseudopelade.

What is Pseudopelade of Brocq?

Pseudopelade of Brocq is rare disease that affects the scalp and causes scarring alopecia resulting in bald patches. Generally no prominent inflammation is observed and only hair loss in patches is noted. These patches vary in shape and size and are random. It usually begins in the vertex region of the scalp, sometimes it stays confined to this area or spreads to the parietal region of the scalp. The patches are smooth, flesh-coloured or white, irregular in shape, and show slight depression. The pathogenesis of Pseudopelade is not known and is often diagnosed when other probable diagnoses are eliminated on a dermatologic exam. The various differential diagnoses of Pseudopelade of Brocq are Discoid Lupus Erythematosus, Lichen Planopilaris, Cental Centrifugal Cicatricial Alopecia, Alopecia Areata, etc.  There are two types identified; one which is primarily idiopathic and other a secondary burnt-out manifestation of other underlying diseases. This is, however, a debate whether Pseudopelade of Brocq is a separate identity or the end-stage of a variety of alopecia disorders like Cicatrical Alopecia, Discoid Lupus Erythematosus, Lichen Planopilaris, etc. The exact cause of the disease is not identifed. Although there are certain suspicions like, autoimmunity, Borrelia infection and probable degeneration of the follicular stem cells. The hair follicle has a niche of stem cells, the destruction of these cells leads to scarring alopecia. Also, damage to the sebaceous glands causes potential hair loss. The disease progress happens in erratic manner, with active and passive episodes.

Who gets Pseudopelade of Brocq and why?

Pseudopelade of Brocq can affect anyone. It can affect individuals of both genders and sometimes children too. However, it is much more prevalent in women in their middle age and above 40 years of age. Pseudopelade lesions initially start as several small patches that fuse together to form large patches known as ‘footprints in the snow’. The development of the disease cannot be predicted. Activity of certain genes has been noted in causing Pseudopelade but there are hardly any reports of multiple familial cases.

Clinical features of Pseudopelade of Brocq

The most obvious clinical feature of Pseudopelade of Brocq is presence of smooth and whitish bald patches on the scalp. Considerable hair thinning, hair loss and atrophy of dermis also can be noted. The condition usually begins at the vertex and then proceeds to the parietal regions. Pseudopelade is mainly confined to the scalp and it is uncommon to observe it in other hair bearing regions of the body. The dermatologic examination looks for several clinical features. There are singular or many light coloured soft patches that are irregular in shape, not crusty, and slightly depressed. The characteristic name given to these patches when they fuse is ‘footprints in the snow’. There is no inflammation observed but follicular degeneration is reported. Pathogenesis cannot be estimated and is varied from person to person. Most of the times the patients are asymptomatic and many are not even aware that they are suffering from Pseudopelade. These factors make the diagnosis and treatment of Pseudopelade a bit challenging.

How is Pseudopelade of Brocq diagnosed?

The diagnosis of Pseudopelade of Brocq is done by a careful clinical and histological examination. The primary cause of the disease is not known and symptoms are non specific, this makes the diagnosis a very difficult task. There are many diseases with similar clinical manifestations and these diseases first need to be eliminated from the diagnosis. Usually a biopsy of the scalp from the patch is done. The positive results show a thin epidermis and sclerotic dermis with presence of fibrosis in the fat layer. Atrophy may be observed; also confined scarring and absence of sebaceous glands are noted. Although Pseudopelade is chronic and progresses disease, it often resolves spontaneously.

Treatment of Pseudopelade of Brocq

There is no standard treatment yet established for Pseudopelade of Brocq. And the treatment administered is also not very effective in many cases. The hair loss caused due to this disease is irreversible and most of the times hair regrowth is not possible. Oral and topical medicines are prescribed to slow or prevent the progression of the disease. Medications like corticosteroids, prednisone, isotretinoin and intralesional steroid injections are prescribed. Hydroxychloroquine is helpful when this disease is accompanied by Discoid Lupus Erythematosus. The dermatologist often does the Hair pull test and then treats the affected area. Cosmetic surgery is one option in patients with remission of the disease.

How long will I be on these treatments?

The progression of this disease is unpredicted so the duration of the treatment varies. Sometimes Pseudopelade of Brocq progresses very slowly and stops at one small patch. However it may advance to form many fused patches resulting in severe disfiguration. One cannot really predict the course of the disease. Thus, the treatment depends on the rate of progression. If the dermatologist finds that the disease has spontaneously resolved and gone into remission, the medications may be stopped.

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