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Skin Appendage Disord 2019 Feb 5;5(2):65-71. Epub 2018 Sep 5.

Department of Dermatology and Dermatopathology, University of California-Irvine, Irvine, California, USA.

Importance: Hair loss, or alopecia, is one of the most commonly presented problems in dermatology. Scarring alopecias are considered particularly damaging due to limited success in slowing permanent disease progression, and current treatment methods, such as intralesional and topical steroids and topical minoxidil, are largely ineffective.

Objective: Hair transplantation is a debated treatment option for advanced cases of primary scarring alopecia. Read More

Indian J Pathol Microbiol 2019 Jan-Mar;62(1):103-106

Department of Dermatology, Maulana Azad Medical College, New Delhi, India.

Objectives: To study the direct immunofluorescence (DIF) in cicatricial alopecia (CA) patients.

Materials And Methods: Approximately, 155 skin biopsies from CA patients examined over 7 years (2009-2015). Special stains and Hematoxylin and Eosin were performed, and final histopathological diagnosis was made. Read More

J Dermatol 2018 Apr 16;45(4):450-455. Epub 2018 Jan 16.

Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Primary scarring alopecia (PSA) is caused by irreversible damage to the hair epithelial stem cells that reside in hair follicles. There is limited published work regarding PSA amongst the Asian population. The aim of this study was to evaluate the clinical features and to characterize the subtypes of PSA in southern Taiwan. Read More

Int J Trichology 2017 Jul-Sep;9(3):113-115

Department of Leprosy, Pramukshwami Medical College, Karamsad, Gujarat, India.

Pseudopelade of Brocq (PPB) is a rare, chronic, slowly progressive cicatricial alopecia that generally affects middle-aged women. Vertex and parietal scalp are commonly involved. It can be primary or secondary to end stage of other scarring alopecia such as lichen planopilaris and discoid lupus erythematosus. Read More

J Am Acad Dermatol 2016 Dec;75(6):1101-1117

Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada; Department of Dermatology, New York University, New York, New York.

Primary cicatricial alopecias can be frustrating for both patients and physicians. Proper diagnosis guides more successful management of these challenging conditions. Part II will cover the remaining lymphocytic primary cicatricial alopecias, which include pseudopelade of Brocq, central centrifugal cicatricial alopecia, alopecia mucinosa, and keratosis follicularis spinulosa decalvans. Read More

Int J Trichology 2015 Jul-Sep;7(3):107-12

Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.

Background: The primary cicatricial alopecias (PCAs) are a rare group of diseases where hair follicle is the primary target of destruction. There are a few studies on histopathological and trichoscopic features of PCA.

Aims: To study the clinical, trichoscopic, and histopathological characteristics of PCAs of the scalp and to find out the concordance between trichoscopic and histopathological diagnosis. Read More

Curr Probl Dermatol 2015 20;47:76-86. Epub 2015 Feb 20.

Scarring alopecia or cicatricial alopecia results from follicular damage that is sufficient to cause the destruction and replacement of pilosebaceous structures by scar tissue. Primary scarring alopecias represent a group of disorders that primarily affect the hair follicles, as opposed to secondary scarring alopecias, which affect the dermis and secondarily cause follicular destruction. Inflammation may predominantly involve lymphocytes or neutrophils. Read More

Actas Dermosifiliogr 2015 May 24;106(4):260-70. Epub 2014 Oct 24.

Servicio de Dermatología, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, España. Electronic address:

The diagnosis of disorders of the hair and scalp can generally be made on clinical grounds, but clinical signs are not always diagnostic and in some cases more invasive techniques, such as a biopsy, may be necessary. This 2-part article is a detailed review of the histologic features of the main types of alopecia based on the traditional classification of these disorders into 2 major groups: scarring and nonscarring alopecias. Scarring alopecias are disorders in which the hair follicle is replaced by fibrous scar tissue, a process that leads to permanent hair loss. Read More

Int J Trichology 2014 Apr;6(2):54-62

Department of Dermatology, Venereology and Leprosy, Government Medical College Bhavnagar, Sir Takhtasinh General Hospital Campus, Bhavnagar, Gujarat, India.

Aims: The aim was to study the trichoscopy features of selected hair and scalp conditions by two dermoscopic devices with different modes that is, polarized (noncontact) and nonpolarized (contact) mode.

Materials And Methods: The present study included 11 clinical varieties of cases with total 112 patients, attending Sir Takhtasinh Hospital, Bhavnagar in the last 2 years. The clinical history was recorded for each case, and images were taken in both the Heine and DermLite II pro dermatoscope. Read More

Int J Trichology 2014 Jan;6(1):27-30

Department of Dermatology and Venereology, Pramukhswami Medical College, Karmasad, Gujarat, India.

Pseudopelade of Brocq (PPB) is a rare, idiopathic self-limiting hair disorder resulting in progressive cicatricial alopecia primarily involving the parietal scalp and vertex. The general pathogenesis of scarring alopecias has been focused on theories of stem cell failure and sebaceous gland destruction. Acquired immunity, Borrelia infection and senescence of follicular stem cell reservoir plays suspected role. Read More

Indian J Dermatol Venereol Leprol 2014 Jul-Aug;80(4):306-12

Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China.

Background: There have been few reports on primary cicatricial alopecias (PCR) especially from Asia (PCA).

Aims: To study the clinical, pathological and dermoscopic characteristics of PCA among Chinese patients.

Methods: A retrospective analysis of the clinical data of 59 patients with PCA was conducted and the dermoscopic, pathological, treatment and prognosis characteristics analyzed. Read More

Ann Dermatol 2014 Apr 30;26(2):214-20. Epub 2014 Apr 30.

Department of Dermatology, Pusan National University School of Medicine, Busan, Korea. ; Medical Research Institute, Pusan National University School of Medicine, Busan, Korea.

Background: Various kinds of alopecia can show small round or oval hairless patch. Dermoscopy could be a simple, useful tool for making a correct diagnosis.

Objective: The aim of this study is to investigate clinical usefulness of dermoscopy for diseases with small round or oval hairless patch on the scalp. Read More

Pak J Biol Sci 2013 Nov;16(22):1609-11

Student Research Committee, Tabriz University of Medical Sciences, Iran.

Cicatricle alopecia represents a diverse group of diseases characterized by a lack of follicular ostia and irreversible alopecia. This study aimed at evaluating cicatricial alopecia in Iranian patients. One hundred patients with cicatricial alopecia were studied. Read More

Clin Dermatol 2013 Nov-Dec;31(6):759-63

Sector of Dermatology and Post-Graduation Course, School of Medicine and University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. Electronic address:

We discuss three controversial situations related to disorders of hair growth and the pilosebaceous unit: alopecia areata incognita, pseudopelade of Brocq, and the association of psoriasis and alopecia. Read More

Facial Plast Surg Clin North Am 2013 Aug;21(3):325-34

Private Practice, 701 Metairie Road, Suite 2A205, Metairie, LA 70005, USA. Electronic address:

It is crucial that hair restoration surgeons understand the basic clinical diagnosis and pathologic condition of other hair loss conditions that are not always amenable to successful hair transplantation. In this article nonscarring and scarring mimickers of androgenetic alopecia are discussed. Nonscarring conditions include alopecia areata, telogen effluvium, and tinea capitis. Read More

Indian J Dermatol Venereol Leprol 2012 Sep-Oct;78(5):637-40

Ann Dermatol Venereol 2011 May 26;138(5):430-3; quiz 429, 434. Epub 2011 Feb 26.

Departements of Dermatology, Allergology and Venereology, Institute of Clinical Medicine, University of Helsinki, Finland.

Ann Dermatol Venereol 2011 May;138(5):373-4

Cutis 2010 Oct;86(4):187-9

Department of Dermatology, University of Pittsburgh Medical Center, Pennsylvania 15213, USA.

We report a case of a white woman with discrete, asymmetrical, noninflammatory areas of hair loss clinically suggestive of pseudopelade of Brocq (PB). However, the histologic features revealed a diagnosis of alopecia areata (AA). We discuss the importance of histopathologic examination in the diagnosis of AA. Read More

Histopathology 2010 Jan;56(1):24-38

Department of Dermatopathology, St John's Institute of Dermatology, St Thomas' Hospital, London, UK.

Interpretation of the histopathological findings of primary scarring and non-scarring alopecias may prove daunting. This is especially true if the biopsy specimen is inadequate, and the clinical history and pattern of the alopecia are not known. Common forms of scarring alopecias discussed here are the lymphocytic (discoid lupus erythematosus, lichen planopilaris, central centrifugal cicatricial alopecia, pseudopelade of Brocq), the neutrophilic (folliculitis decalvans, dissecting folliculitis), and the mixed (acne keloidalis) entities. Read More

J Dermatol Sci 2010 Jan 22;57(1):27-36. Epub 2009 Nov 22.

Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.

Background: Lichen planopilaris (LPP) and pseudopelade of Brocq (PPB) are two scarring alopecia diagnoses that exhibit similar clinical features. Some suggest LPP and PPB are not distinct diseases, but rather different clinical presentations in a spectrum derived from the same underlying pathogenic mechanism.

Objective: We explored the degree of similarity between LPP and PPB gene expression patterns and the potential for common and unique gene pathway and gene activity in LPP and PPB using microarrays. Read More

Clinics (Sao Paulo) 2008 Dec;63(6):747-52

Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.

Background: Scarring alopecias are classified into primary and secondary types according to the initial site of inflammation. In primary scarring alopecias, the hair follicle is the main target of destruction; the term secondary cicatricial alopecia implies that follicular destruction is not the primary pathologic event.

Aims: To review the histopathologic diagnoses of cases of cicatricial alopecia in order to classify them according to the North American Hair Research Society. Read More

Dermatol Ther 2008 Jul-Aug;21(4):257-63

Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada.

Pseudopelade of Brocq (PPB) is a rare, idiopathic, slowly progressive hair disorder, resulting in cicatricial alopecia. It typically presents in Caucasian adult patients as small, smooth, flesh-toned and slightly depressed alopecic patches with irregular outlines. It primarily involves the parietal and vertex portions of the scalp with a chronic prolonged course. Read More

Skinmed 2008 Jan-Feb;7(1):19-26

Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.

In this 2-part article, the authors review the primary cicatricial alopecias. Primary cicatricial alopecia can be defined as predominantly lymphocytic, neutrophilic, or mixed based on the nature of the follicular infiltrate that is present around affected hair follicles. Lymphocytic primary cicatricial alopecias include chronic cutaneous lupus erythematosus (discoid lupus erythematosus), lichen planopilaris, classic pseudopelade of Brocq, central centrifugal cicatricial alopecia, alopecia mucinosa, and keratosis follicularis spinulosa decalvans. Read More

Acta Dermatovenerol Croat 2006 ;14(4):246-52

University Department of Dermatology and Venereology, Sestre milosrdnice University Hospital, Zagreb, Croatia.

There are numerous dermatoses which may cause cicatricial alopecia when localized on the scalp, such as chronic discoid lupus erythematosus (DLE), lichen planus, graft-versus-host disease, dermatomyositis, scleroderma, cicatricial pemphigoid, porphyria cutanea tarda, follicular mucinosis, perifolliculitis capitis abscedens, lichen sclerosus et atrophicus, necrobiosis lipoidica, sarcoidosis, etc. Histologically, cicatricial alopecia is characterized by dermal scarring, along with absent or reduced hair follicles and reduced number of erector pili muscles. According to working classification of cicatricial alopecia by the North American Hair Society, primary cicatricial alopecia may be divided into the following categories: lymphocytic group (e. Read More

Dermatology 2005 ;211(2):98-102

Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.

Background: There are diverse causes of cicatricial alopecia characterized by lack of follicular ostia and irreversible loss of hair. While clinical differentiation between the causes may be difficult, particularly with regard to lichen planus (LP), lupus erythematosus (LE) and pseudopelade of Brocq (PB), it has been suggested that both histopathologic examination and direct immunofluorescence studies (DIF) are necessary for an accurate diagnosis.

Objective: The aim of this study was to evaluate the diagnostic value of DIF studies in addition to histopathology in patients with cicatricial alopecia as a clinical feature. Read More

J Am Acad Dermatol 2005 Apr;52(4):637-43

University of California, San Francisco, San Francisco, California, USA.

Background: Primary cicatricial alopecias encompass a group of disorders characterized by permanent destruction of the hair follicle. The varied clinical features and differences in terminology have led to difficulties in defining consistent clinicopathologic correlation.

Objective: We sought clinicopathologic correlation of 6 clinically distinct primary cicatricial alopecias: lichen planopilaris, frontal fibrosing alopecia, pseudopelade (Brocq), central centrifugal alopecia, folliculitis decalvans, and tufted folliculitis. Read More

Lupus 2004 ;13(6):455-62

Second Dermatology Clinic, Department of Dermatological Sciences, University of Florence, Florence, Italy.

Scarring alopecia is a very frequent feature of chronic discoid lupus erythematosus (DLE). So far in the literature, only clinic-pathologic features or histopathologic-immunopathologic traits of DLE scarring alopecia (DLESA) have been reported. We describe the most significant features of clinical morphology, histopathology, serum and tissue immunopathology of 36 DLESA patients (41. Read More

Br J Dermatol 2004 Jul;151(1):84-90

2nd Dermatology Clinic, Department of Dermatological Sciences, University of Florence, Azienda Sanitaria di Firenze, Via della Pergola 60, 50121 Florence, Italy.

Background: Pseudopelade of Brocq (PB) is an acquired progressive cicatricial alopecia which is characterized by some distinctive clinical features. It may represent either a distinct entity, i.e. Read More

Br J Dermatol 2003 Jun;148(6):1271; author reply 1271-2

Br J Dermatol 2002 Mar;146(3):532-3

Int J Dermatol 2002 Jan;41(1):8-15

Department of Dermatological Sciences, University of Florence, Florence, Italy.

Background: Pseudopelade of Brocq (PB) is a permanent progressive scarring alopecia characterized by numerous alopecic patches localized only in the scalp, that tend to coalesce into larger, irregular plaques with policyclic borders. PB can be considered either the final atrophic stage of several scarring disorders such as lichen planus pilaris (LPP) and discoid lupus erythematosus (DLE) (secondary PB) or an autonomous disease (primary PB). The aim of this study was to assess the incidence of primary vs. Read More

J Am Acad Dermatol 2000 May;42(5 Pt 2):895-6

Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada.

Pseudopelade is a rare self-limited hair disorder, resulting in cicatricial alopecia. It presents with skin-colored alopecic patches primarily involving the parietal and vertex portions of the scalp. This is a case report of a patient with pseudopelade that involves both his scalp and beard area. Read More

Hautarzt 1999 Dec;50(12):897

Hautklinik, Krankenhauses Dresden-Friedrichstadt-Städtisches Klinikum.

Hautarzt 1998 Nov;49(11):835-7

Hautklinik des Klinikums Heilbronn, Akademisches Lehrkrankenhaus, Universität Heidelberg.

The differential diagnosis of cicatricial alopecia includes a wide variety of diseases. A 60-years-old woman was admitted to the hospital because of an unsuccessfully treated, progressive pseudopelede of Brocq. Further examination revealed an borreliosis (Stage III). Read More

Hautarzt 1998 Jun;49(6):462-72

Dermatologische Universitätsklinik und Poliklinik der Charité, Humboldt-Universität zu Berlin.

Numerous different diseases lead to scarring alopecia with irreversible follicular destruction as a common ending. Current classifications are based on clinical, histopathological or prognostic parameters, as well as on pathogenetic criteria which allow only a rough assessment because the precise mechanisms leading to scarring alopecia are still unknown. Inadequacies of the established classifications are obvious when regarding special forms of scarring alopecia like lichen planopilaris or pseudopelade Brocq. Read More

Clin Exp Dermatol 1994 Jan;19(1):61-4

Department of Dermatology, Royal Berkshire Hospital, Reading, UK.

The cases of two brothers who both developed pseudopelade at the age of 7 years, with progressive patchy hair loss, are reported. Biopsy in the elder brother showed typical changes with reduced numbers of hair follicles and sebaceous glands, a sparse lymphocytic infiltrate and an absence of widespread scarring. A third family member may have been affected. Read More

Cutis 1993 Feb;51(2):99-105

Department of Dermatology, College of Physicians and Surgeons of Columbia University, Columbia Presbyterian Medical Center in the City of New York 10032.

Four patients are presented with pseudopelade of Brocq whose symptoms also illustrate the spectrum of symptoms of lichen planus. The literature is reviewed and the clinical and histologic features of pseudopelade of Brocq and lichen planopilaris are described. The literature on pseudopelade of Brocq is confusing and outdated. Read More

Hautarzt 1993 Jan;44(1):37-9

Universitäts-Hautklinik Mannheim.

We present a 59-year old male patient, who had small plant cylinders 1-2 mm in length adhering to the hair shafts and easily moved up and down along them. We found hair casts together with lichen ruber follicularis and pseudopelade of the Brocq type. The presence of hair casts is often misdiagnosed as pediculosis capitis, piedra alba or trichorrhexis nodosa. Read More

J Am Acad Dermatol 1991 Nov;25(5 Pt 1):865-6

J Am Acad Dermatol 1990 Nov;23(5 Pt 1):944-5

Department of Dematology, University of Michigan, Ann Arbor.

Hautarzt 1989 Feb;40(2):77-83

Dermatologische Klinik, Ludwig-Maximilians-Universität München.

In 1885 Brocq described a type of scarring alopecia he called pseudopelade (PPB), whose character as a separate disease entity has been denied in recent decades. Several authors now believe PPB to be a polyetiological final stage (état pseudopeladique de Degos; EPP). In all, 142 patients with scarring alopecia were analyzed in an attempt to find whether PPB is a separate entity or not. Read More

Dermatologica 1987 ;174(1):49-50

Dermatologica 1986 ;172(1):18-23

41 cases with scarring alopecia seen from 1979 to 1983 were analyzed and differentiated. After exclusion of 7 cases with lichen planopilaris, of 5 cases with discoid lupus erythematosus, of 2 cases with scleroderma, and of 1 case with folliculitis decalvans, there remained 26 cases. The clinical histological and direct immunofluorescence (DIF) findings in these patients suggest that pseudopelade of Brocq might be a distinct disease unrelated to other known types of scarring alopecia. Read More

J Cutan Pathol 1978 Jun;5(3):93-104

Elastic fiber stain (acid alcoholic orcein) reveals diagnostically significant differences between several types of alopecia of the scalp. A short outline of elastic fiber distribution on the normal hair follicle emphasizes the elastic coat of the follicular isthmus, the sparsity of elastic fibers on the cyclic lower portion of the hair root, and the presence in the neck of the dermal papilla of an elastin-like body which is formed anew with each hair cycle. This body provides a marker of the gradual shortening of successive anagen hairs in male pattern alopecia. Read More

Cutis 1976 May;17(5):916-8

Immunofluorescence studies as as the underlying cause of pseudopelade of Brocq (PPOB) in a middle-aged woman. The routine use of immunofluorescent studies in clinical cases of pseudopelade of Brocq might make more specific diagnoses possible. Read More

J Invest Dermatol 1955 Mar;24(3):323-35

Proc R Soc Med 1943 Apr;36(6):282-3

Proc R Soc Med 1934 Dec;28(2):114

Proc R Soc Med 1934 Dec;28(2):114