PSEUDOPELADE OF

 

BROCQ

 

In clinical terms, pseudopelade of Brocq implies fleshto pink-colored, irregularly shaped alopecia that may begin in a “moth-eaten” or characteristic “footprints-in-the-snow” pattern with eventual coalescence into larger patches of alopecia There is no follicular erythema or hyperkeratosis, yet the disease may progress inexorably. There has been considerable debate as to the specificity of this diagnosis versus an assignation of the term to describe all noninflammatory scarring alopecias, including the end-stage of a variety of initially inflammatory conditions. Histologically, the lesions are characterized by a perifollicular and perivascular lymphocytic infiltrate primarily at the level of the follicular infundibulum, loss of sebaceous epithelium, and fibrotic streams into the subcutis without interface or follicular plugging changes. Elastin stains may distinguish pseudopelade (persistent elastic fibers around the midshaft of the follicle) from lichen planopilaris and lupus erythematosus (loss of elastic fibers in this location). Direct immunofluorescence is negative in the majority of cases. However, in general, the histology is similar, if not identical, to that of lichen planopilaris. It is unclear whether any treatment helps.