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Brocq Pseudopelade

  • Author: Kendall M Egan, MD, FAAD; Chief Editor: William D James, MD  more...
 
Updated: Oct 30, 2015
 

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 erythematosus (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

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

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, FAAD Dermatologist, Veteran's Affairs Medical Center; Dermatologist, Spruce Health, Dermatologist, DermOne

Kendall M Egan, MD, FAAD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists

Disclosure: Nothing to disclose.

Coauthor(s)

Kimberly L Maino, MD Mohs Surgeon and Dermatologist, Aurora Skin Care Center

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

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, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

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

Disclosure: Nothing to disclose.

Acknowledgements

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. 2008 Jul-Aug. 21(4):257-63. [Medline].

  3. Braun-Falco O, Plewig G, Wolff H, Burgdorf W, eds. Diseases of Hair. 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. 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. Dermatology. 2nd ed. Spain: Elsevier; 2008. 1000.

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

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

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

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

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

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

  12. Rakowska A, Slowinska M, Kowalska-Oledzka E, Warszawik O, Czuwara J, Olszewska M, et al. Trichoscopy of cicatricial alopecia. J Drugs Dermatol. 2012 Jun. 11(6):753-8. [Medline].

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

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

  15. Nikam VV, Mehta HH. A nonrandomized study of trichoscopy patterns using nonpolarized (contact) and polarized (noncontact) dermatoscopy in hair and shaft disorders. Int J Trichology. 2014 Apr. 6 (2):54-62. [Medline]. [Full Text].

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

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

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

  19. Unger W, Unger R, Wesley C. The surgical treatment of cicatricial alopecia. Dermatol Ther. 2008 Jul-Aug. 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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