Pseudopelade of Brocq (PPB) is a hair loss condition with great debate behind the activity of the condition. There is thought that PPB is an actively smoldering primary inflammatory condition that can be slowed or stopped. Another belief is that PPB is the end result of any inflammatory alopecia and no further treatment is needed. The mechanism is unknown as to why this occurs. There are speculations about the cause of PPB including Borrelia infection, auto-immune origins, or genetics with or without environmental influences.
PPB primarily affects middle-aged and older women although all ages including men and children can be affected as well. Many patients are not aware of the condition and it usually starts without symptoms and progresses slowly. Patients may notice smooth or dimpled patches of alopecia at the crown or sides of the scalp. These patches can contain single hairs, are usually skin colored, without scale or itching, and can track around the scalp like “footprints in the snow.”
PPB is diagnosed through scalp examination and biopsy. A biopsy is warranted to rule out other causes of inflammatory alopecia which can mimic PPB such as alopecia areata, discoid lupus, or lichen planopilaris. PPB is considered an inflammatory disorder although inflammation may or may not be visualized on the biopsy. When that biopsy is examined the follicles in PPB appear to be atrophic with shorter and finer hairs.
Treatment includes finding and treating any underlying inflammatory conditions. Topical steroid liquids and creams, scalp injections, oral anti-inflammatory medications can slow or stop the progression of PPB. PPB is self-limited and can start and stop without the patient knowing or without treatment. The endpoint can leave a few patches of alopecia to almost total scalp baldness. With any alopecia that can start again without symptoms, close follow-up is necessary to monitor for flares. Early detection and treatment can prevent progression of hair loss and possibly reverse alopecia if caught early.