Pseudopelade of Brocq (PPB) or Brocq’s alopecia is a rare hair disorder that results in scarring alopecia.
While some consider it a separate condition, there are others who believe that the pseudopelade of Brocq is the end stage of other scarring alopecias like lichen planopilaris or lupus. However, there are many studies that prove otherwise.
In this guide, we’ll explore what the pseudopelade of Brocq is and what you can do to manage it.
What Is The Pseudopelade Of Brocq?
Pseudopelade of Brocq is a type of cicatricial alopecia. French dermatologist Louis-Anne-Jean Brocq named this type of hair loss in 1888 after noticing a similarity to alopecia areata.
“Pelade” comes from the word “pelage,” which refers to the woolly, furry or hairy coat of a mammal. However, in medicine, “pelade” also refers to alopecia areata. Since Brocq’s alopecia is not actually alopecia areata, it’s called the “pseudo-pelade” of Brocq.
Its appearance is described as being “footprints in the snow,” commonly affecting the parietal and crown (vertex) regions of the scalp. But it can spread to other areas and has even been reported in the beard.
This condition can come and go. There can be periods of active hair loss followed by periods of dormancy. And the progression of hair loss can be slow or fast and sudden. Although, it’s usually the former.
More commonly, the pseudopedale of Brocq affects white women above the age of 40. However, it can also affect men and children, the latter being very rare.
What is the difference between alopecia areata and pseudopedale of Brocq?
Alopecia areata differs from the pseudopedale of Brocq in that it is not scarring, whereas the latter is scarring (cicatricial) alopecia. Where alopecia areata is typically reversible, pseudopedale of Brocq can cause permanent hair loss. There can, however, be some similarities between the two, such as hair loss occurring in patches.
Types Of Pseudopelade Of Brocq
Because there’s some controversy around the status of pseudopelade of Brocq being a unique type of hair loss, it’s usually divided into two categories. These are as follows:
- Primary Pseudopelade – Characterised by permanent hair loss believed to be a result of immune problems that end up damaging the hair follicle stem cells.
- Secondary Pseudopelade – Refers to the “burnt-out” or “end-stage” inflammatory scarring alopecias (lichen planopilaris, lupus).
However, again, there are studies that show that Brocq’s alopecia is its own type of hair loss. For instance, a study published in the Journal of Dermatological Science found genetic differences between lichen planopilaris and pseudopelade of Brocq.
Future research may help clear up the ambiguities.
Pseudopedale Of Brocq Pictures
Numerous case reports describe patients with Pseudopedale of Brocq. A few of them are as follows:
1. “Shiny atrophic patches of alopecia over occipital regions”
Diwan N, Gohil S, Nair PA. Primary idiopathic pseudopelade of brocq: five case reports. Int J Trichology. 2014 Jan;6(1):27-30. doi: 10.4103/0974-7753.136759. PMID: 25114452; PMCID: PMC4124692/CC BY-NC-SA 3.0
2. “Wide irregular, scarring alopecia on the vertex of the scalp.”
Usama Bin Shabbir M, Afridi F, Waheed A, Alvi R, Hamza Gul M, Wardak AB. Unmasking pseudopelade of Brocq in male adult: a rare case report. Ann Med Surg (Lond). 2025 Jan 9;87(1):380-382. doi: 10.1097/MS9.0000000000002815. PMID: 40109647; PMCID: PMC11918724/CC BY-ND 4.0
3. “Wide irregular, scarring alopecia on the vertex of the scalp.”
Nair PA, Singhal R, Pariath K. Primary Idiopathic Pseudopelade of Brocq in a Young Child. Int J Trichology. 2017 Jul-Sep;9(3):113-115. doi: 10.4103/ijt.ijt_24_17. PMID: 28932062; PMCID: PMC5596645/CC BY-NC-SA 3.0
What Are The Symptoms Of Pseudopelade Of Brocq?
Following are the signs and symptoms of Brocq’s alopecia:
- Small, irregularly-shaped hair loss patches
- Slightly depressed atrophic plaques on the skin
- Hair follicle scarring
- Soft, smooth skin
- Hypopigmentation
- Absence of sebaceous glands (that produce oil)
- No inflammation
- Slight itchiness
- Shiny scalp
While this type of hair loss is usually seen at the back of the scalp, it can visibly affect other areas as well.
There are some people who develop only one patch on their scalp. However, there are others who develop patches that engulf other areas of their scalp over time (lasting for years).
What Is The Trichoscopy Of The Pseudopedale Of Brocq?
According to research, trichoscopic findings of the pseudopedale of Brocq can include “cadaverized hair, thin hair, white dots, loss of follicles and white areas.” However, it’s also been noted that the trichoscopic features of this condition are “non-specific” and require a “diagnosis of exclusion both clinically and trichoscopically.”
What Causes Pseudopelade Of Brocq?
The exact cause of the pseudopelade of Brocque isn’t known. However, there are different theories as to why it happens.
Some believe that it’s an autoimmune condition in which the body’s immune cells start attacking healthy cells. As a result, the stem cells in the hair follicles are damaged. And without stem cells, it’s not possible to regrow new hair. That’s what leads to permanent alopecia.
Other than that, some research indicates a genetic link. For instance, a case report in Clinical and Experimental Dermatology described a case in which two 7-year-old brothers developed this kind of hair loss. Potentially, another member of the family was also affected.
Lastly, Borrelia burgdorferi, a type of bacteria, may also be potentially implicated in this condition, according to research. It’s the same organism that causes Lyme disease.
What Is The Treatment For Pseudopelade Of Brocq?
There’s no standardised treatment for the pseudopelade of Brocq. However, steroids (oral and injections), immunosuppressants, antimalarials, isotretinoin, minoxidil, hydroxychloroquine, and antirejection medicine have been prescribed for its treatment.
Unfortunately, these are not as effective in the treatment of this condition. Still, a treatment plan may be developed depending on how severe your problem is.
If Brocq lesions have stabilised, it is possible for you to undergo a hair transplant procedure. A 60% positive outcome has been reported for hair transplantation in the case of pseudopedale of Brocq in one study.
However, it’s only possible to have this surgery if your condition has been in remission for 1-2 years. And even as you get surgery, you should be aware of the risk that the pseudopelade of Brocq can come back.
Experiencing Hair Loss?
Longevita arranges surgical and non-surgical treatments for hair loss in both London and Istanbul. We connect you with independent, highly skilled professionals to ensure a high patient satisfaction rate. If you want to learn more about our offerings, feel free to get in touch.
Frequently Asked Questions
Unfortunately, the pseudopelade of Brocq is a chronic condition, but it’s possible for it to go into remission.
According to DermNet, there’s no treatment that works for pseudopelade of Brocq. Prescribed drugs have also shown limited efficacy. So, essential oils are unlikely to work.
Dr Cagla
Dr Cagla earned her medical degree at Trakya University’s Faculty of Medicine in Bulgaria and has almost 6 years of hair transplantation experience. She is a specialist in FUE, DHI and Sapphire hair transplants of the scalp, eyebrows and beard and has performed over 6,000 surgeries. Dr Cagla is multilingual, with fluency in English, Bulgarian and Turkish.
