Primary Cicatricial Alopecia: Clinical Features and Management

Elizabeth K. Ross, MD

Dermatology Nursing. 2007;19(2):137-143.

Pseudopelade of Brocq

This primary cicatricial alopecia is named after a French dermatologist who was the first to study the condition in great detail in the late 1800s. He and others appreciated similarities in its appearance to "pelade," the French term for alopecia areata, hence the name pseudopelade. The following description of the pseudopelade of Brocq will be based on Brocq et al.'s description of the condition.

Pseudopelade of Brocq is a scalp disorder of middle-aged adults. Unlike lichen planopilaris, patients with pseudopelade of Brocq rarely have symptoms and visible signs of inflammation. A positive pull test, which yields anagen hairs when the disease is active, is a useful sign, but is not always present. Presentations include small oval or large round patches; the affected scalp surface may resemble "footsteps in the snow" (see Figure 4) or the entire central scalp may be affected diffusely. The scarred areas are usually completely devoid of hair and the skin supple and white.

(Enlarge Image)

Pseudopelade of Brocq. Patchy variant, which resembles the nonscarring disorder alopecia areata. Source: Photo courtesy of Paradi Mirmirani, MD.

Treatment approaches are similar to those described for lichen planopilaris. Treatment response is judged by the extent of scalp involved as neither symptoms nor inflammatory signs of disease are usually available to judge efficacy. Sometimes a followup biopsy is used to assess treatment response.

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Proposed Working Classification of Primary Cicatricial Alopecia
Lymphocytic Lichen planopilaris Lichen planopilaris Frontal fibrosing alopecia Graham-Little syndrome Classic pseudopelade (Brocq) Central centrifugal cicatricial alopecia Chronic cutaneous lupus erythematosus (discoid lupus erythematosus) Alopecia mucinosa Keratosis follicularis spinulosa decalvans Neutrophilic Folliculitis decalvans Dissecting cellulitis/folliculitis (perifolliculitis capitis abscedens et suffodiens) Mixed Folliculitis (acne) keloidalis Folliculitis (acne) necrotica Erosive pustular dermatosis Nonspecific (End Stage)

Note: Entities discussed are shown in italics.
Source: Adapted from Olsen et al., 2003.

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