Pseudopelade

PSEUDOPELADE, pseudopelade (pelade = French name for alopecia areata Brocq; synonyms: alopecia atrophicans areolata, alopecia cicatrisata Besnier-Crocker, alopecia pseudoareata, pseudoarea, alopecie atrophiante en clairieres Darier and others), a relatively rare chronic disease of the skin, mainly affecting the hairy part of the head, described in 1885 by Brocq. Pseudopelade is one of the skin diseases of the group of atrophic or scarring alopecias (pseudopelade, folliculitis decalvans, ulerythema sycosiforme and others). Men are more frequently affected. The most affected age is from 20 to 45 years. There are cases of familial pseudopelade (Rosenberg). Clinically, pseudopelade is characterized by the sudden appearance on the hairy part of the head, less frequently on the beard, mostly numerous, less frequently single, of various shapes and sizes, sharply demarcated white patches, completely devoid of hair. Upon careful examination of these patches, greater or lesser atrophy of the skin is noted. The foci slowly increase in size, some merge, sometimes forming something like a geographical archipelago. The absence of visible inflammatory phenomena is characteristic. The roots of the fallen hairs have a thick, juicy transparent sheath. Pseudopelade is not accompanied by subjective sensations and is often discovered only by chance. The duration of the disease varies, up to several decades. A variety of pseudopelade with multiple small foci was isolated by Dreuw under the name alopecia parvimaculata. Histologically - follicular scar sclerosis; along with the phenomena of skin atrophy, there is a perifollicular, mainly lymphocytic infiltrate. Differential diagnosis is mainly with alopecia areata, post-febrile alopecia, lupus erythematosus and folliculitis decalvans. Unlike alopecia areata, in pseudopelade the skin in areas devoid of hair is atrophied, slightly retracted, and devoid of follicular openings. Post-febrile alopecia is characterized by coarser scars; the remaining hairs are dry and as if dusty, resembling tow. The scars on the hairy part after lupus erythematosus are deeper than in pseudopelade, and in most cases are surrounded by an erythematous-hyperkeratotic process that has not yet ended. From folliculitis or acne decalvans Lailler and folliculite epilante et destructive Quinquaud, pseudopelade differs in the absence of visible folliculitis. Etiology is unknown: some (Brandweiner and others) see in pseudopelade a special variety of alopecia areata and speak of a trophoneurosis of the skin, others (Sabouraud, P. Photinos and others) adhere to the microbial theory, although sufficient evidence for it has not yet been obtained. The prognosis is unfavorable: in the vast majority of cases, it is not possible to stop the further progression of the process. Treatment: rubbing in mercury, sulfur, tar and other ointments, as well as washing the affected areas 2 times a day with hot water and soap (Arndt). Photinos recommends preliminary epilation.