Brocq Pseudopelade Workup

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

Laboratory Studies

Other than scalp biopsy, no laboratory test has been found useful in establishing the diagnosis of pseudopelade of Brocq. If the history or physical examination findings suggest evidence of lupus erythematosus, antinuclear antibody testing would be appropriate.

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Procedures

Scalp biopsy

Two 4-mm deep punch biopsy specimens should be obtained from an orientation along the direction of the hair follicle. Specimens should ideally be taken from a clinically well-established but active area of alopecia to include both normal and affected hair-bearing areas. One punch biopsy specimen should be submitted for horizontal sectioning and one for vertical sections if possible, both stained with hematoxylin and eosin and elastic tissue stains. The second punch biopsy specimen can be bisected vertically to accommodate both direct immunofluorescence (DIF) and hematoxylin and eosin staining.[7]

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Histologic Findings

The histopathologic criteria established by Pinkus were not correlated in any way with the clinical features.[15] Thus, pseudopelade as described by Pinkus is a histologic and not a clinical entity. In secondary pseudopelade, the histologic findings are those of a burnt-out scarring alopecia with absent hair follicles and fibrosis. Elastic tissue is absent in scarred areas. Idiopathic pseudopelade is characterized by a contracted dermis with dense collagen and loss of space between collagen bundles. Elastic fibers are recoiled and appear thick. Broad fibrous tract remnants are noted with preservation of the elastic sheath.

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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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