Brocq Pseudopelade Workup
- Author: Kendall M Egan, MD, FAAD; Chief Editor: William D James, MD more...
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.
Two 4-mm 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.
The histopathologic criteria established by Pinkus were not correlated in any way with the clinical features. 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.
Brocq L. Les folliculites et perifolliculites decalvantes. Bull Mem Soc Med Hop Paris. 1888. 5:339-408.
Alzolibani AA, Kang H, Otberg N, Shapiro J. Pseudopelade of Brocq. Dermatol Ther. 2008 Jul-Aug. 21(4):257-63. [Medline].
Braun-Falco O, Plewig G, Wolff H, Burgdorf W, eds. Diseases of Hair. Dermatology. 2nd ed. New York, NY: Springer-Verlag; 2000. 1120-21.
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.
Bolognia J, Jorizzo J, Rapini R. Alopecias. Dermatology. 2nd ed. Spain: Elsevier; 2008. 1000.
Sellheyer K, Bergfeld WF. Histopathologic evaluation of alopecias. Am J Dermatopathol. 2006 Jun. 28(3):236-59. [Medline].
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].
Bulengo-Ransby SM, Headington JT. Pseudopelade of Brocq in a child. J Am Acad Dermatol. 1990 Nov. 23(5 Pt 1):944-5. [Medline].
Collier PM, James MP. Pseudopelade of Brocq occurring in two brothers in childhood. Clin Exp Dermatol. 1994 Jan. 19(1):61-4. [Medline].
Sperling LC, Solomon AR, Whiting DA. A new look at scarring alopecia. Arch Dermatol. 2000 Feb. 136(2):235-42. [Medline].
Sperling LC, Cowper SE. The histopathology of primary cicatricial alopecia. Semin Cutan Med Surg. 2006 Mar. 25(1):41-50. [Medline].
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].
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].
Khong JJ, Casson RJ, Huilgol SC, Selva D. Madarosis. Surv Ophthalmol. 2006 Nov-Dec. 51(6):550-60. [Medline].
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].
Sahl WJ. Pseudopelade: an inherited alopecia. Int J Dermatol. 1996 Oct. 35(10):715-9. [Medline].
Pinkus H. Differential patterns of elastic fibers in scarring and non-scarring alopecias. J Cutan Pathol. 1978 Jun. 5(3):93-104. [Medline].
Bergner T, Braun-Falco O. Pseudopelade of Brocq. J Am Acad Dermatol. 1991 Nov. 25(5 Pt 1):865-6. [Medline].
Unger W, Unger R, Wesley C. The surgical treatment of cicatricial alopecia. Dermatol Ther. 2008 Jul-Aug. 21(4):295-311. [Medline].