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Suffering Alopecia. Have Scalp Skin Biopsy Done. What Are The Findings And Treatment?
Question: Scalp Skin Biopsy Report : Section shows skin. The epidermis is unremarkable. The dermis show a loss of hair follicles with occassional fibrous cords instead. There is increase in elastic fibres along with fibrosis which is seen extending into the subcutis as well. Inflammation is not very severe with mild to moderate perivascular lymphocytic infiltrate.
There is no evidence of basal cell vauolation.
Result:- Consistent with Psuedopelade of Brocq.
Query -
1. This biopsy was done at the time of start of Cicatricial Alopecia years ago. Could you kindly explain the type of alopecia in detail [Simple Terms] and whether this kind of alopecia is reversable or not ?
2. How different is Skin Biopsy from Scalp Sonography and which one is suitable to know the current condition and treatment options?
3. Any new treatment options available for such a condition ?
There is no evidence of basal cell vauolation.
Result:- Consistent with Psuedopelade of Brocq.
Query -
1. This biopsy was done at the time of start of Cicatricial Alopecia years ago. Could you kindly explain the type of alopecia in detail [Simple Terms] and whether this kind of alopecia is reversable or not ?
2. How different is Skin Biopsy from Scalp Sonography and which one is suitable to know the current condition and treatment options?
3. Any new treatment options available for such a condition ?
Hi XXXXXXX
Thanks for your query.
I have gone through your report and it is consistent with Psuedopelade of Brocq.
Now firstly let me make you aware of the condition that you are having .
In simple terms, this is a skin condition leading to irreversible loss of hair from the affected area. It is an unusual form of permanent hair loss from the scalp, the cause of which is unknown. This means that the areas of the scalp which are affected by Psuedopelade of Brocq never grow hair again. You need to be fully aware about this fact. Now the positive side however is that, with treatment , we can arrest or minimize the further progression of the patches of hair loss to some extent.
Pseudopelade of Brocq can reactivate episodically and unpredictably. If active inflammation is present, treatment may be reasonable and should focus on preventing disease progression. Even with treatment, pseudopelade of Brocq may worsen. Standardized treatment does not however exist.
Most dermatologist prefer to start with topical steroid application or intralesional steroid injections at the margins of the patches. This may help in arresting the further progression of hair loss. Coming to the oral treatment, long oral steroids can be given in rapidly progressing cases. Oral drugs like hydroxychloroquine have also been used with some success in preventing progression. But all these therapies are not very promising. They may give results in some patients, and hence are tried with some success.
Systemic therapy should be initiated and followed by a dermatologist who is familiar with the condition and experienced with using the above systemic medications. Pseudopelade, like most scarring alopecias, is difficult to treat and, in general, responds poorly to treatment.
Now coming to the surgical aspects of treatment, surgical correction can be used to treat scarring alopecia. As a general rule, the disease process should be dormant or stable for at least 1 year.
In terms of unstable forms of alopecia, excision is the preferred surgical treatment.
But the surgical repair may be affected by future recurrences of their disease. Hair transplantation and flap procedures are less preferred surgical methods for treating unstable alopecia.
Now as far as your skin biopsy report is concerned, the various features that are seen are consistent with the diagnosis of pseudopelade. And skin biopsy is the most confirmatory diagnostic test used in these cases. There is nothing much that a scalp ultrasonography will tell us, other than just confirming the diagnosis.
And The diagnosis of pseudopelade is mostly a clinical one, so I would not advise you to go for a scalp sonography.There is a loss of hair follicles as shown in the biopsy report, which tells us that there are no hair follicles, so very less chances of hair regrowth.
Hope it helps
If you have any other query, kindly let me know.
Dr Geetika Paul
Thanks for your query.
I have gone through your report and it is consistent with Psuedopelade of Brocq.
Now firstly let me make you aware of the condition that you are having .
In simple terms, this is a skin condition leading to irreversible loss of hair from the affected area. It is an unusual form of permanent hair loss from the scalp, the cause of which is unknown. This means that the areas of the scalp which are affected by Psuedopelade of Brocq never grow hair again. You need to be fully aware about this fact. Now the positive side however is that, with treatment , we can arrest or minimize the further progression of the patches of hair loss to some extent.
Pseudopelade of Brocq can reactivate episodically and unpredictably. If active inflammation is present, treatment may be reasonable and should focus on preventing disease progression. Even with treatment, pseudopelade of Brocq may worsen. Standardized treatment does not however exist.
Most dermatologist prefer to start with topical steroid application or intralesional steroid injections at the margins of the patches. This may help in arresting the further progression of hair loss. Coming to the oral treatment, long oral steroids can be given in rapidly progressing cases. Oral drugs like hydroxychloroquine have also been used with some success in preventing progression. But all these therapies are not very promising. They may give results in some patients, and hence are tried with some success.
Systemic therapy should be initiated and followed by a dermatologist who is familiar with the condition and experienced with using the above systemic medications. Pseudopelade, like most scarring alopecias, is difficult to treat and, in general, responds poorly to treatment.
Now coming to the surgical aspects of treatment, surgical correction can be used to treat scarring alopecia. As a general rule, the disease process should be dormant or stable for at least 1 year.
In terms of unstable forms of alopecia, excision is the preferred surgical treatment.
But the surgical repair may be affected by future recurrences of their disease. Hair transplantation and flap procedures are less preferred surgical methods for treating unstable alopecia.
Now as far as your skin biopsy report is concerned, the various features that are seen are consistent with the diagnosis of pseudopelade. And skin biopsy is the most confirmatory diagnostic test used in these cases. There is nothing much that a scalp ultrasonography will tell us, other than just confirming the diagnosis.
And The diagnosis of pseudopelade is mostly a clinical one, so I would not advise you to go for a scalp sonography.There is a loss of hair follicles as shown in the biopsy report, which tells us that there are no hair follicles, so very less chances of hair regrowth.
Hope it helps
If you have any other query, kindly let me know.
Dr Geetika Paul
Above answer was peer-reviewed by :
Dr. Mohammed Kappan
If i have understood correctly - the chances of surgical or medicinal treatment succeeding are minimal other than for preventive arrest or further progression of the disease??
If there is no further progression of disease, as hair loss is already extensive, for the past 1 yr but skin (where there is complete hair loss) shows a slight purple pigmentation, what is the cause of pigmentation and can it be treated?? If i prefer to go in for a laser hair removal of the balance hair left, i would not want that once i have completely gone bald, that such pigmentation shows and gives a diseased look.
Is there any complication in going in for a Laser Hair Removal as hair loss is permanent??
If there is no further progression of disease, as hair loss is already extensive, for the past 1 yr but skin (where there is complete hair loss) shows a slight purple pigmentation, what is the cause of pigmentation and can it be treated?? If i prefer to go in for a laser hair removal of the balance hair left, i would not want that once i have completely gone bald, that such pigmentation shows and gives a diseased look.
Is there any complication in going in for a Laser Hair Removal as hair loss is permanent??
Hi XXXXXXX
See I understand your concern regarding the bluish pigmentation. This pigmentation is usually an indicator of the underlying pathology which caused the hair loss.
Bluish pigmentation leads us to two causes i.e. lichen planus ...which could have caused the hair loss. Now both of these lead to irreversible hair loss leaving areas of pigmentation.
Now regarding your question, the bluish pigmentation is because the underlying skin still has components of the original pathology. I am afraid that it is usually very difficult to correct the pigmentation. We can temporarily decrease it with certain lightening agents but it tends to recur.
Regarding, laser hair removal of the rest of hair, it is one option, but the pigmentation will still be noticeable and being patchy, it won’t solve the cosmetic problem. Although there is no significant other complications associated with this treatment
Your problem is at present stable as far as I can make out, so I would suggest you to try for certain other options like hair weaving, which gives good and cosmetically appealing results in such cases. There are many good centers at Delhi which are carrying out hair weaving with good results.
As far as hair transplantation is concerned, for that you might need a scalp analysis first by a trained dermatologist who is into hair transplant who can assess an let you know whether it will be feasible or not.
Hope that answers your concern
If there is any other query, kindly let me know
Dr Geetika Paul
See I understand your concern regarding the bluish pigmentation. This pigmentation is usually an indicator of the underlying pathology which caused the hair loss.
Bluish pigmentation leads us to two causes i.e. lichen planus ...which could have caused the hair loss. Now both of these lead to irreversible hair loss leaving areas of pigmentation.
Now regarding your question, the bluish pigmentation is because the underlying skin still has components of the original pathology. I am afraid that it is usually very difficult to correct the pigmentation. We can temporarily decrease it with certain lightening agents but it tends to recur.
Regarding, laser hair removal of the rest of hair, it is one option, but the pigmentation will still be noticeable and being patchy, it won’t solve the cosmetic problem. Although there is no significant other complications associated with this treatment
Your problem is at present stable as far as I can make out, so I would suggest you to try for certain other options like hair weaving, which gives good and cosmetically appealing results in such cases. There are many good centers at Delhi which are carrying out hair weaving with good results.
As far as hair transplantation is concerned, for that you might need a scalp analysis first by a trained dermatologist who is into hair transplant who can assess an let you know whether it will be feasible or not.
Hope that answers your concern
If there is any other query, kindly let me know
Dr Geetika Paul
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Mohammed Kappan
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