By Gary M. White, MD
Pseudopelade is an idiopathic, scarring alopecia characterized by round to oval areas of hair loss like footprints in the snow.
Round to oval, non-inflamed, white, alopetic areas of the scalp, like footprints in the snow are characteristic. No crust, scale or follicular hyperkeratosis occurs. There may be perifollicular erythema early and moderate atrophy in late stages. Most patients are women. The course is chronic with slow progression.
The key differential is cutaneous lupus erythematosus or lichen planopilaris. Indeed, some experts feel that pseudopelade is merely a clinical diagnosis and represents the end stage of a scarring alopecia, e.g., lichen planopilaris.
A biopsy is usually necessary to establish the diagnosis. If signs of either lichen planus or lupus are seen, appropriate therapy should be considered. In cases where one is left with the diagnosis of pseudopelade and if progression is noted, hydroxychloroquine may be tried. In the case of old, stable, burned-out disease, hair transplant or scalp reduction may be considered.
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