Brocq Pseudopelade 

  • Author: Kendall M Egan, MD; Chief Editor: William D James, MD   more...
 
Updated: Aug 16, 2011
 

Background

In 1888, Brocq used the term pseudopelade to describe a unique form of cicatricial alopecia resembling alopecia areata (Pelade is the French term for alopecia areata).[1] Over the last century, this condition has been a source of controversy.

While some believe pseudopelade a unique entity, most now believe that it is an end stage or clinical variant of various forms of cicatricial alopecia.[2] The same pattern of alopecia can be found in end-stage discoid lupus erythematous (DLE), lichen planopilaris (LLP), and other forms of cicatricial alopecia. The confusion is further amplified by a difference in definition between different countries. For example, in Germany, all types of inflammatory cicatricial alopecia are included in the grouping of pseudopelade. In contrast, American dermatologists have used the term as a diagnosis of exclusion.[3]

Pseudopelade of Brocq is not a specific disease, but a pattern of cicatricial alopecia.[4] If a definitive diagnosis of DLE, LLP, or another condition can be made based on clinical, histological, or immunofluorescent features, then the term pseudopelade of Brocq cannot be used. A primary form of traditional pseudopelade may exist, but this has yet to be established with certainty.

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Pathophysiology

The following 2 types of pseudopelade of Brocq are recognized:

  • Burnt-out or end-stage scarring alopecias (eg, LLP, DLE)[5] - Pathophysiology corresponds to underlying disease process
  • Primary idiopathic pseudopelade - Pathophysiology unknown

Pseudopelade of Brocq is considered end-stage permanent alopecia. The general pathogenesis of scarring alopecias has focused on the following theories of thought[6, 7] :

  • Stem cell failure: The bulge region of the hair follicle houses follicular stem cells. These cells are essential for hair growth. Direct damage to the bulge region may cause permanent scarring hair loss.
  • Sebaceous gland destruction: The sebaceous gland connects to the hair follicle just superior to where the inner root sheath degenerates. This degeneration is required for the hair shaft to exit the skin normally. The sebaceous gland may have a crucial role in this process.
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Epidemiology

Frequency

International

The true prevalence of pseudopelade of Brocq in the general population is unknown, but it would appear to be very uncommon.

Mortality/Morbidity

Pseudopelade of Brocq patients may have emotional distress due to the progressive nature of the disorder and the poor response to treatment.

Race

Pseudopelade of Brocq is more common in whites.

Sex

Females are affected by pseudopelade of Brocq more often than males. The typical patient is a middle-aged woman with type 2 skin.

Age

Although pseudopelade of Brocq has been reported rarely in children,[8, 9] the onset most commonly occurs between ages 30 and 50 years.

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Contributor Information and Disclosures
Author

Kendall M Egan, MD  Staff Dermatologist, Department of Dermatology, Naval Medical Center San Diego

Kendall M Egan, MD is a member of the following medical societies: American Academy of Dermatology, California Society of Dermatology and Dermatologic Surgery, and Pacific Dermatologic Association

Disclosure: Nothing to disclose.

Coauthor(s)

Kimberly L Maino, MD  Head, Dermatologic Surgery/Oncology, Mohs Micrographic Surgery, Department of Dermatology, Naval Medical Center San Diego

Kimberly L Maino, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Medical Association, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Evan R Farmer, MD  Clinical Professor of Pathology and Dermatology, Department of Pathology, Virginia Commonwealth University School of Medicine

Evan R Farmer, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, and International Society of Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD  Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Leonard Sperling, MD, to the development and writing of this article.

References

  1. Brocq L. Les folliculites et perifolliculites decalvantes. Bull Mem Soc Med Hop Paris. 1888;5:339-408.

  2. Alzolibani AA, Kang H, Otberg N, Shapiro J. Pseudopelade of Brocq. Dermatol Ther. Jul-Aug 2008;21(4):257-63. [Medline].

  3. Braun-Falco O, Plewig G, Wolff H, Burgdorf W, eds. Diseases of Hair. In: Dermatology. 2nd ed. New York, NY: Springer-Verlag; 2000:1120-21.

  4. Sperling LC. Brocq's alopecia (pseudopelade of Brocq) and "burnt out" scarring alopecia. In: Sperling LC, ed. An Atlas of Hair Pathology: With Clinical Correlations. London, England: Parthenon; 2003:115-8.

  5. Bolognia J, Jorizzo J, Rapini R. Alopecias. In: Dermatology. 2nd ed. Spain: Elsevier; 2008:1000.

  6. Sellheyer K, Bergfeld WF. Histopathologic evaluation of alopecias. Am J Dermatopathol. Jun 2006;28(3):236-59. [Medline].

  7. Otberg N, Wu WY, McElwee KJ, Shapiro J. Diagnosis and management of primary cicatricial alopecia: part I. Skinmed. Jan-Feb 2008;7(1):19-26. [Medline].

  8. Bulengo-Ransby SM, Headington JT. Pseudopelade of Brocq in a child. J Am Acad Dermatol. Nov 1990;23(5 Pt 1):944-5. [Medline].

  9. Collier PM, James MP. Pseudopelade of Brocq occurring in two brothers in childhood. Clin Exp Dermatol. Jan 1994;19(1):61-4. [Medline].

  10. Sperling LC, Solomon AR, Whiting DA. A new look at scarring alopecia. Arch Dermatol. Feb 2000;136(2):235-42. [Medline].

  11. Sperling LC, Cowper SE. The histopathology of primary cicatricial alopecia. Semin Cutan Med Surg. Mar 2006;25(1):41-50. [Medline].

  12. Madani S, Trotter MJ, Shapiro J. Pseudopelade of Brocq in beard area. J Am Acad Dermatol. May 2000;42(5 Pt 2):895-6. [Medline].

  13. Khong JJ, Casson RJ, Huilgol SC, Selva D. Madarosis. Surv Ophthalmol. Nov-Dec 2006;51(6):550-60. [Medline].

  14. Sahl WJ. Pseudopelade: an inherited alopecia. Int J Dermatol. Oct 1996;35(10):715-9. [Medline].

  15. Pinkus H. Differential patterns of elastic fibers in scarring and non-scarring alopecias. J Cutan Pathol. Jun 1978;5(3):93-104. [Medline].

  16. Bergner T, Braun-Falco O. Pseudopelade of Brocq. J Am Acad Dermatol. Nov 1991;25(5 Pt 1):865-6. [Medline].

  17. Unger W, Unger R, Wesley C. The surgical treatment of cicatricial alopecia. Dermatol Ther. Jul-Aug 2008;21(4):295-311. [Medline].

 
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Irregularly shaped patch of scarring alopecia on the occiput of a middle-aged white woman. This asymptomatic lesion was first discovered by the patient's hairdresser.
 
 
 
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