Pseudopelade of Brocq is a rare, cicatricial (scarring) alopecia (hair loss condition) that affects the scalp. It is named after the French dermatologist Albert Brocq, who first described the condition in 1906. Pseudopelade of Brocq is also known as scarring alopecia, cicatricial alopecia, and sclerosing keratosis.
Cicatricial alopecias are a group of hair loss conditions that result in the destruction of hair follicles, which are replaced by scar tissue. This type of hair loss is permanent, as the hair follicles are destroyed and cannot regrow hair. In contrast, non-cicatricial alopecias, such as androgenetic alopecia (male/female pattern baldness), result in hair thinning but do not destroy the hair follicles.
Pseudopelade of Brocq is characterized by patches of hair loss on the scalp that are smooth and shiny, with no signs of inflammation or scaling. The patches of hair loss gradually increase in size over time, and the affected areas may become scarred and permanently bald. In severe cases, the hair loss can involve the entire scalp.
Causes
The exact cause of pseudopelade of Brocq is not fully understood, but there are several factors that are thought to contribute to its development.
- Genetics: Some research suggests that genetics may play a role in the development of pseudopelade of Brocq. The condition appears to have a strong hereditary component, as it is often seen in families. However, the specific genetic factors that contribute to the development of pseudopelade of Brocq are not yet known.
- Inflammation: Inflammation is believed to play a key role in the development of pseudopelade of Brocq. The hair follicles in affected individuals are often surrounded by inflammatory cells, indicating that an immune response is taking place. This immune response can damage the hair follicles and lead to scarring, which can result in permanent hair loss.
- Trauma: Trauma to the scalp, such as from tight hairstyles, chemical treatments, or physical injury, can also contribute to the development of pseudopelade of Brocq. The trauma can cause inflammation and damage to the hair follicles, which can then lead to scarring and hair loss.
- Hormonal imbalances: Hormonal imbalances, such as those seen in conditions like polycystic ovary syndrome (PCOS) and thyroid disorders, can also contribute to the development of pseudopelade of Brocq. These hormonal imbalances can lead to changes in hair growth and hair loss, which can then result in scarring of the hair follicles.
- Infections: Certain infections, such as fungal infections of the scalp, can also contribute to the development of pseudopelade of Brocq. These infections can cause inflammation and damage to the hair follicles, which can then lead to scarring and hair loss.
- Autoimmune disorders: Autoimmune disorders, such as lupus and lichen planopilaris, can also contribute to the development of pseudopelade of Brocq. These disorders cause the immune system to attack the hair follicles, leading to inflammation, damage, and scarring.
- Environmental factors: Environmental factors, such as exposure to toxins and pollutants, can also play a role in the development of pseudopelade of Brocq. These environmental factors can cause damage to the hair follicles and lead to inflammation and scarring, which can result in hair loss.
- Aging: As individuals age, their hair follicles can become damaged, leading to scarring and hair loss. This age-related hair loss can contribute to the development of pseudopelade of Brocq, especially in individuals who are predisposed to the condition due to genetics or other factors.
The exact mechanisms by which these various factors contribute to the development of pseudopelade of Brocq are not fully understood. However, it is thought that the combination of genetic predisposition, inflammation, and other factors leads to scarring of the hair follicles, which in turn results in permanent hair loss.
Symptoms
The main symptoms of Pseudopelade of Brocq include:
- Hair Loss: One of the most noticeable symptoms of this condition is patchy hair loss on the scalp. The patches of hair loss are typically round or oval in shape and may be limited to one area or scattered throughout the scalp. The hair loss is permanent and cannot be reversed.
- Scalp Scarring: As the hair follicles are destroyed, the skin on the scalp becomes scarred, giving the affected area a smooth, shiny appearance. The skin may also become thickened and tighter, making it difficult to move the scalp.
- Scalp Itching: Many patients with Pseudopelade of Brocq experience itching of the scalp, which can be mild to severe. The itching may be accompanied by a burning or stinging sensation.
- Scalp Pain: Some patients may experience pain or tenderness in the affected areas of the scalp. The pain may be mild or severe and may be accompanied by a burning or stinging sensation.
- Nodules: In some cases, small nodules or lumps may develop on the scalp. These nodules may be tender or painful and may be accompanied by itching or burning.
- Eyebrow and Eyelash Loss: In some cases, the hair loss associated with the Pseudopelade of Brocq may extend to the eyebrows and eyelashes. This can result in a loss of facial hair, which can have a significant impact on a person’s appearance.
- Nail Changes: Some patients with Pseudopelade of Brocq may experience changes in their nails, such as ridging, splitting, or thinning.
- Systemic Symptoms: In rare cases, patients with Pseudopelade of Brocq may experience systemic symptoms, such as fatigue, fever, weight loss, and joint pain.
Diagnosis
Diagnosis of Pseudopelade of Brocq typically involves a combination of a physical examination, medical history review, and various tests to rule out other causes of hair loss. The following is a list of the main diagnostic tests and procedures for Pseudopelade of Brocq:
- Physical examination: The first step in diagnosing Pseudopelade of Brocq is a thorough physical examination of the scalp. This includes a visual examination of the affected areas, as well as a close examination of the hair and scalp under a microscope to identify any signs of inflammation or damage to the hair follicles.
- Medical history review: The physician will ask about the patient’s medical history, including any previous illnesses, medications, and treatments that may have contributed to the hair loss. The patient may also be asked about any family history of hair loss or autoimmune disorders.
- Blood tests: Blood tests may be performed to check for a variety of conditions that can cause hair loss, including autoimmune disorders such as lupus and thyroid disease. These tests may include a complete blood count (CBC), a comprehensive metabolic panel (CMP), and tests for levels of iron, vitamin D, and thyroid hormones.
- Scalp biopsy: A scalp biopsy is often used to confirm the diagnosis of Pseudopelade of Brocq. During this procedure, a small sample of skin and hair follicles from the affected area is removed and examined under a microscope. This allows the physician to determine if there is any damage to the hair follicles and to rule out other causes of hair loss.
- Trichoscopy: Trichoscopy is a non-invasive diagnostic tool that uses a special type of microscope to examine the hair and scalp. This tool allows the physician to see the hair shafts and follicles in detail, and to identify any signs of inflammation or damage.
- Dermoscopy: Dermoscopy is similar to trichoscopy, but uses a polarized light source to examine the hair and scalp. This allows the physician to see deeper into the hair follicles and to identify any signs of scarring or damage.
Once the diagnosis of Pseudopelade of Brocq has been confirmed, the physician may recommend a variety of treatments to slow or stop the progression of the hair loss. These may include topical or oral medications, light therapy, and hair transplantation.
It is important to note that there is no cure for Pseudopelade of Brocq, and the hair loss is permanent. However, early diagnosis and treatment can help slow or stop the progression of the hair loss and prevent further damage to the hair follicles.
Treatment
There is no cure for Pseudopelade of Brocq, but there are several treatments available to manage the symptoms and slow the progression of the disease. The main treatments for Pseudopelade of Brocq include:
- Topical and oral corticosteroids: Corticosteroids are a type of medication that reduce inflammation and suppress the immune system. Topical corticosteroids can be applied directly to the scalp, while oral corticosteroids are taken by mouth. These medications can help reduce inflammation and slow the progression of hair loss in some people with Pseudopelade of Brocq.
- Topical minoxidil: Minoxidil is a medication that is applied to the scalp to stimulate hair growth. It is thought to work by increasing blood flow to the hair follicles, which can help to revitalize the hair follicles and promote hair growth.
- Immunosuppressive medications: In some cases, immunosuppressive medications may be prescribed to suppress the immune system and reduce the inflammation that is causing hair loss. These medications can include methotrexate, cyclosporine, and azathioprine.
- Wigs, hairpieces, and hair extensions: For people with more advanced hair loss, wigs, hairpieces, and hair extensions can be used to cover up the hairless patches. These can be made from natural or synthetic hair and can be custom-fitted to match the individual’s hair color, texture, and style.
- Scalp micropigmentation: Scalp micropigmentation is a cosmetic procedure that involves tattooing tiny dots of pigment onto the scalp to create the illusion of hair stubble. This can be a good option for people with extensive hair loss who want to restore the appearance of a full head of hair.
- Hair transplantation: In some cases, hair transplantation may be an option for people with Pseudopelade of Brocq. This involves removing hair follicles from one area of the scalp and transplanting them to the hairless patches. However, hair transplantation may not be effective in all cases, as the transplanted hair may also be affected by the autoimmune disorder.
- Support groups: Joining a support group can be a valuable resource for people with Pseudopelade of Brocq. These groups provide a safe and supportive environment for people to share their experiences and connect with others who are going through similar experiences.
It is important to note that the effectiveness of these treatments may vary from person to person, and some people may not respond to any of the treatments available. In addition, the progression of hair loss in Pseudopelade of Brocq can be unpredictable, and some people may experience a sudden increase in hair loss even with treatment.
Corticosteroids are the most commonly used medication for the treatment of Pseudopelade of Brocq. Topical corticosteroids can be applied directly to the scalp and are usually well-tolerated. They can help reduce inflammation and slow the progression of hair loss in some people with Pseudopelade of Brocq.
