Pseudopelade of the Central Scalp

Pseudopelade of the central scalp is a rare form of scarring alopecia, a type of hair loss that occurs due to the destruction of hair follicles. It is characterized by the presence of small, round, well-defined patches of hair loss on the scalp, often in the central area. The hair loss in pseudopelade of the central scalp is permanent and there is no cure for the condition. However, treatment options are available to help manage the symptoms and improve the appearance of the affected area.

Pseudopelade of the central scalp is a type of scarring alopecia that affects the central area of the scalp. It is also known as central pseudopelade, central scarring alopecia, and central cicatricial alopecia. The term “pseudopelade” is derived from the Greek word “pseudos” meaning false and “pelade” meaning baldness. The term “central” refers to the location of hair loss on the scalp. Pseudopelade of the central scalp is considered a rare condition and is often misdiagnosed as other types of hair loss, such as male or female pattern baldness. The exact cause of pseudopelade of the central scalp is unknown, but it is believed to be related to an autoimmune or inflammatory process.

Causes

The cause of pseudopelade is not well understood, but it is believed to be a result of a combination of genetic and environmental factors. The following are the main lists of causes of pseudopelade of the central scalp.

1. Autoimmune Disorders

Pseudopelade is often associated with autoimmune disorders such as lupus erythematosus, scleroderma, and dermatomyositis. In these conditions, the immune system mistakenly attacks healthy hair follicles, leading to scarring and permanent hair loss.

2. Trauma

Trauma to the scalp, such as burns or cuts, can cause scarring and hair loss. Scarring alopecia can also develop as a result of repeated mechanical trauma, such as tight braiding or hair styling practices that pull on the hair.

3. Infections

Infections, such as folliculitis or cellulitis, can cause scarring and hair loss in the affected area. Fungal infections, such as tinea capitis, can also cause hair loss and scarring.

4. Neoplasms

Cancerous and benign tumors can cause scarring and hair loss in the affected area. These tumors can cause hair loss by compressing hair follicles or by producing chemicals that interfere with hair growth.

5. Hormonal Imbalances

Hormonal imbalances, such as those associated with hypothyroidism or hyperthyroidism, can cause hair loss and scalp scarring. Hormonal imbalances can cause hair loss by altering the growth cycle of hair follicles.

6. Nutritional Deficiencies

Nutritional deficiencies, such as those associated with iron-deficiency anemia, can cause hair loss and scalp scarring. Nutritional deficiencies can cause hair loss by interfering with the growth and maintenance of hair follicles.

7. Drug-Induced Alopecia

Certain medications, such as chemotherapy drugs, can cause hair loss and scalp scarring. Drug-induced alopecia can cause hair loss by altering the growth cycle of hair follicles or by causing scarring.

8. Idiopathic Causes

In some cases, the cause of pseudopelade is unknown, and it is referred to as idiopathic. Idiopathic pseudopelade is thought to be a result of a combination of genetic and environmental factors.

9. Family History

A family history of hair loss and scalp scarring can increase the risk of developing pseudopelade. Family history suggests that there may be a genetic component to the condition.

10. Age

As people age, they are more likely to experience hair loss and scalp scarring. Age-related hair loss and scalp scarring can be caused by a variety of factors, including hormonal imbalances, nutritional deficiencies, and autoimmune disorders.

Symptoms

The main symptoms of this condition are characterized by the gradual loss of hair, leaving behind a smooth, bald patch in the center of the scalp. In some cases, this condition can also result in permanent hair loss, leaving the affected area with no chance of regrowth.

1. Hair Thinning and Bald Patches One of the most obvious symptoms of pseudopelade of the central scalp is the gradual thinning of hair in the affected area. This thinning of hair often leads to the development of bald patches in the center of the scalp, which can range in size from a few millimeters to several centimeters. These bald patches are usually round or oval in shape and are well-defined, with a clear border separating the affected area from the surrounding hair.
2. Scalp Inflammation Another symptom of pseudopelade of the central scalp is the presence of inflammation on the scalp in the affected area. This inflammation is usually accompanied by itching, redness, and burning sensations, which can be quite uncomfortable. In some cases, the inflammation can also result in the formation of small blisters or pustules, which can further worsen the condition.
3. Scarring Alopecia Pseudopelade of the central scalp is classified as a type of scarring alopecia, which means that the hair loss is caused by the destruction of the hair follicles. In this condition, the hair follicles are replaced by scar tissue, which results in permanent hair loss. This can lead to the formation of a smooth, bald patch in the center of the scalp, which cannot be restored by hair transplantation or other medical treatments.
4. Itching and Burning Sensations In addition to the inflammation and bald patches, pseudopelade of the central scalp can also cause itching and burning sensations on the scalp. This can be quite uncomfortable, and in some cases, it can be severe enough to interfere with daily activities. In some cases, the itching and burning sensations can also result in the formation of secondary infections, which can further worsen the condition.
5. Nail Changes Pseudopelade of the central scalp can also result in changes in the nails, such as brittle nails, onycholysis, or subungual hyperkeratosis. These changes can indicate the presence of an underlying autoimmune disease, and it is important to seek medical attention if you are experiencing these symptoms.
6. Psychological Impact Hair loss can have a significant impact on a person’s self-esteem and self-confidence, and this is especially true for those with pseudopelade of the central scalp. This condition can result in noticeable bald patches in the center of the scalp, which can be quite noticeable and embarrassing. In some cases, this can lead to anxiety, depression, and other psychological issues, and it is important to seek support from friends, family, and healthcare professionals.

Diagnosis

Diagnosis

The diagnosis of pseudopelade of the central scalp is made through a combination of physical examination, medical history, and laboratory tests. The physical examination includes a thorough inspection of the scalp, including the presence of scarring and hair loss. The medical history will be reviewed to determine if the patient has a history of skin conditions or infections that may have contributed to the development of pseudopelade.

Laboratory tests are used to rule out other medical conditions that may be causing hair loss, such as fungal infections, hormonal imbalances, or autoimmune disorders. These tests may include a scalp biopsy, blood tests, and skin culture.

A scalp biopsy is a diagnostic tool that involves removing a small sample of skin from the affected area. This sample is then examined under a microscope to determine the type and extent of the damage to the hair follicles. Blood tests can be used to check for hormonal imbalances, autoimmune disorders, and other medical conditions that may be contributing to hair loss. Skin culture is used to identify any fungal or bacterial infections that may be contributing to hair loss.

Tests

There are several tests that can be used to diagnose pseudopelade of the central scalp. These tests include:

1. Scalp biopsy: This test is performed to determine the extent and type of damage to the hair follicles. The biopsy will be examined under a microscope to determine if there is any scarring or damage to the follicles.
2. Blood tests: Blood tests are used to check for hormonal imbalances, autoimmune disorders, and other medical conditions that may be contributing to hair loss.
3. Skin culture: Skin culture is used to identify any fungal or bacterial infections that may be contributing to hair loss.
4. Trichogram: A trichogram is a test that involves removing a small sample of hair from the affected area and examining it under a microscope. This test can determine if the hair loss is due to a medical condition or if it is due to damage to the hair follicles.
5. Dermoscopy: Dermoscopy is a test that involves using a special tool to examine the scalp and hair under a microscope. This test can help to determine the cause of hair loss and identify any underlying medical conditions.

Treatment

There are several treatment options available for pseudopelade of the central scalp, but it is important to note that there is no cure for the condition. The goal of treatment is to slow down the progression of hair loss and manage the symptoms.

1. Topical and oral medications – Topical medications, such as minoxidil, are often used to treat hair loss. Minoxidil is a vasodilator that increases blood flow to the hair follicles and promotes hair growth. It can be applied topically to the scalp and is available over the counter. Oral medications, such as finasteride, are also used to treat hair loss. Finasteride is a type of 5-alpha reductase inhibitor that reduces the production of dihydrotestosterone (DHT), which is a hormone that contributes to hair loss. It is only available with a prescription and should not be taken by women who are pregnant or planning to become pregnant.

2. Corticosteroids – Corticosteroids are often used to treat pseudopelade of the central scalp. They work by reducing inflammation and slowing down the progression of hair loss. Corticosteroids can be applied topically to the scalp or taken orally.

3. Scalp transplant – A scalp transplant is a procedure in which a small sample of skin is taken from the scalp for examination under a microscope. This is done to determine the how of hair loss and to rule out other conditions. A scalp biopsy is an important step in the diagnosis and treatment of pseudopelade of the central scalp.

4. Hair transplantation – Hair transplantation is a surgical procedure in which hair follicles are taken from one area of the scalp and transplanted to another area. This can be done to restore hair growth in areas of the scalp that have been affected by hair loss. Hair transplantation is not recommended for individuals with pseudopelade of the central scalp, as the hair follicles may be damaged and may not grow back.

5. Scalp micropigmentation – Scalp micropigmentation is a cosmetic procedure in which pigment is applied to the scalp to create the appearance of hair. This can be done to cover up areas of the scalp that have been affected by hair loss. Scalp micropigmentation is not a cure for pseudopelade of the central scalp, but it can help to improve the appearance of the scalp.

6. Wigs and hairpieces – Wigs and hairpieces can be used to cover up areas of the scalp that have been affected by hair loss. These can be made from synthetic or human hair and can be custom-made to fit the individual’s head. Wigs and hairpieces are a good option for individuals who do not want to undergo surgery or other treatments.

7. Support groups – Support groups can provide individuals with pseudopelade of the central scalp with a supportive community and a place to share their experiences and receive advice from others.

Medical Treatments

a. Topical and Oral Corticosteroids

Topical and oral corticosteroids are the most commonly used medical treatments for pseudopelade of the central scalp. Corticosteroids are anti-inflammatory drugs that can reduce inflammation and swelling in the affected area. They can also reduce the severity of hair loss and improve hair regrowth. Topical corticosteroids are applied directly to the scalp, while oral corticosteroids are taken orally.

b. Minoxidil

Minoxidil is a topical solution that is applied directly to the scalp. It is believed to increase blood flow to the hair follicles, which can improve hair growth. Minoxidil is also believed to increase the size of the hair follicles, which can help to prevent further hair loss.

c. Dutasteride

Dutasteride is an oral medication that is used to treat male pattern baldness. It works by blocking the conversion of testosterone to dihydrotestosterone (DHT), which is the hormone responsible for hair loss. Dutasteride can also be used to treat pseudopelade of the central scalp, as it has been shown to improve hair growth in some patients.

d. Finasteride

Finasteride is an oral medication that is used to treat male pattern baldness. It works by blocking the conversion of testosterone to DHT, which is the hormone responsible for hair loss. Finasteride has also been shown to improve hair growth in some patients with pseudopelade of the central scalp.

2. Surgical Treatments

a. Scalp Reduction Surgery

Scalp reduction surgery is a surgical procedure that involves removing a portion of the scalp that is affected by hair loss. The remaining scalp is then pulled together and sutured to reduce the size of the bald area. Scalp reduction surgery can be an effective treatment for pseudopelade of the central scalp, as it can improve hair growth and reduce the severity of hair loss.

b. Hair Transplantation

Hair transplantation is a surgical procedure that involves removing hair follicles from one area of the scalp and transplanting them to the affected area. Hair transplantation can be an effective treatment for pseudopelade of the central scalp, as it can improve hair growth and reduce the severity of hair loss.

3. Alternative Treatments

a. Scalp Massage

Scalp massage is a gentle massage technique that is performed on the scalp. It is believed to increase blood flow to the hair follicles, which can improve hair growth. Scalp massage can also help to reduce stress and promote relaxation, which can have a positive impact on hair growth.

b. Laser Therapy

Laser therapy is a non-invasive treatment that involves the use of low-level lasers to stimulate hair growth.

References