Can Pseudopelade Return Once it's Cleared Up?'

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Name: Beatriz

Question: I started to get small bald patches on the left side of my head in 2015. After visiting a dermatologist in 2016 I was diagnosed with pseudopelade de brocq. I was prescribed a liquid steroid solution which I applied once per day. I visited the dermatologist a few months later and they felt the condition was no longer active, and said that it doesn't generally return?

This has remained the case until a month ago when I felt that I was losing hair again and the areas appeared larger. My hairdresser noticed that around my lower hairline, and at the front of my hair above my forehead was thinner but queried if this was more hormonal hair loss as my hair appears drier at the moment.

What is the timescale of pseudopelade and can it return again once it has cleared up? Also, when I went for a second opinion they told me I had lichen planopilaris - are these conditions similar and are the treatments and outcomes the same?

pseudopelade scarring alopecia
An Example of Pseudopelade

Answer: Hi, Beatriz. Pseudopelade can indeed recur and the duration, or how long it takes before it goes into remission, cannot be predicted.

It tends to present in a way that can resemble footprints in the snow and affects three times as many women as it does men, though little is known about its causes, comings and goings.

Pseudopelade is a form of scarring hair loss, which can destroy the hair follicles, leaving permanent baldness in the affected areas. It is part of a group of conditions collectively known as Cicatricial Alopecia or Alopecia Cicatrisata.

Lichen planopilaris also belongs to this group, and both lichen planopilaris and psedopelade are autoimmune disorders with similar symptoms. Most of those affected by lichen planopilaris - an estimated 60 to 90 per cent of cases - are women.

Examples of hair loss from Lichen Planopilaris - cicatricial alopecia

It is a skin disorder, lichen planus, but is known as lichen planopilaris when it affects hair-bearing areas. Symptoms of the condition include erythema - a redness of the skin around sites of inflammation, scaling and hyperkeratotic plugs (thickened outer layers of the skin).

Although sometimes said to be related to stress, this is largely thought to be more due to stress being detrimental to our general well-being and the body's healing process, including how it responds to autoimmune disorder medications, than stress being any kind of trigger, unlike in other autoimmune diseases, such as Alopecia Areata.

According to the US Department of Health and Human Services' Genetic and Rare Disease Information Centre, there "exists some controversy as to whether [pseudopelade de Brocq] is a distinct condition or the common final stage or variant of several different forms of scarring alopecias such as discoid lupus erythematosus (DLE) or lichen planopilaris (LPP). Some have suggested abandoning the use of the term pseudopelade of Brocq while others think that the term should be strictly used to describe patients that follow the pattern of hair loss described by Brocq et al.(i.e., multiple, small, discrete, asymmetrical, smooth, soft, flesh-colored or white patches of hair loss with little, if any, inflammation)."

Often, where there is confusion over the diagnosis, a scalp biopsy is recommended in order to to tell these hair loss conditions apart. As such, you may wish to discuss this option with your dermatologist.

At Belgravia we cannot treat either of these conditions but those who can often do so using medications, such as corticosteroid lotions or scalp injections, to address the underlying condition, rather than providing any type of hairloss solution.

Once the condition has been stable for three years, some surgeons may consider carrying out a hair transplant or even scalp reduction surgery, though this is decided very much on a case-by-case basis. These are both highly-skilled procedures and require specialist experience and training so, if you were to explore either of these options, we would recommend speaking to a respected and qualified expert in this particular surgical field first.

It is worth noting that, even once the condition has been stable for the requisite amount of time, and if you are judged suitable for surgical hair restoration, the procedure still may not be a success.

As before, we recommend discussing your options with one of the dermatologists you mentioned seeing, as they should be able to provide you with further advice on getting a confirmed diagnosis and suitable therapies based on these findings.

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