Pseudopelade of Brocq is an uncommon form of primary cicatricial alopecia that progresses slowly and presents as smooth, atrophic patches on the scalp, typically affecting the parietal area and vertex. Because its clinical appearance overlaps with both scarring and non-scarring alopecias, diagnosis is often delayed, making early clinical recognition especially important.

We describe a 21-year-old man with a 10-year history of slowly enlarging areas of hair loss. The initial lesions were several small, smooth patches that gradually merged to involve a large portion of the parietal scalp and vertex. On examination, he exhibited a broad, irregularly shaped, slightly hyperpigmented atrophic patch spanning the vertex, parietal, and frontal scalp. Additional skincolored, atrophic patches over the temporal regions produced a characteristic “footprints-in-thesnow” pattern. There was no evidence of erythema, scaling, or follicular hyperkeratosis, and the hair pull test was negative. Dermoscopic evaluation showed absent follicular openings without perifollicular inflammatory signs.

Histopathology revealed epidermal thinning with hyperkeratosis, elongated rete ridges, preservation of the granular layer, and melanin incontinence at the basal layer. The dermis demonstrated perifollicular fibrocollagenous scarring, loss of sebaceous glands, and mild lymphocytic infiltration, but no significant active inflammation. Standard laboratory tests were unremarkable.

The patient received both systemic and intralesional corticosteroids, which helped halt further progression. After tapering the steroids, oral isotretinoin was introduced. Although hair regrowth was limited, the condition remained stable on follow-up. This case illustrates the diagnostic importance of identifying subtle scarring changes and dermoscopic loss of follicular openings to distinguish pseudopelade of Brocq from non-cicatricial conditions such as alopecia areata, enabling more accurate counseling and long-term management. 

Uzma Fatima completed her dermatology residency at K.N.R. University of Health Sciences in Telangana, India. She currently serves as the Director of Dr. Uzma’s Skin and Hair Clinic in Hyderabad, where she practices both medical and aesthetic dermatology. Her approach emphasizes individualized, evidence-based care for patients with diverse skin and hair concerns.