Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2023;13(2):e2023088 1

Elastic Stain in Pseudopelade of Brocq: a Helpful 
Histopathological Diagnostic Clue

Gloria Baeza-Hernández1, Mercedes Isabel Jaquero-Valero2, Ricardo Francisco 
Rubio-Aguilera1, Luis Carlos Araya-Umaña2, Celia Horcajada-Reales1,  

Amalia Moreno-Torres2

1 Dermatology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain

2 Pathology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain

Citation: Baeza-Hernández G, Jaquero-Valero MI, Rubio-Aguilera RF, Araya-Umaña LC, Horcajada-Reales C, Moreno-Torres A.  
Elastic Stain in Pseudopelade of Brocq: a Helpful Histopathological Diagnostic Clue. Dermatol Pract Concept. 2023;13(2):e2023088.  
DOI: https://doi.org/10.5826/dpc.1302a88

Accepted: October 6, 2022; Published: April 2023

Copyright: ©2023 Baeza-Hernández et al. This is an open-access article distributed under the terms of the Creative Commons 
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted 
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding Author: Gloria Baeza-Hernández, Servicio de Dermatología Hospital de Fuenlabrada, Camino del Molino 2,  
28942 Fuenlabrada, Madrid. E-mail: gloria.baeza@salud.madrid.org

Case Presentation

A 50-year-old Caucasian woman presented to the derma-

tology clinic complaining of hair loss over at least 5 years, 

without itching or redness. A 4 mm punch biopsy fixed in 

10% buffered formalin was sent to our laboratory and then 

vertically bisected for analysis (Figure 1). It showed features 

of scarring alopecia, with a syringomatous proliferation in 

a fibrous zone; with orcein stain dense elastic fibers could 

be observed within a fibrous tract that extended below and 

above the insertion of the arrector pili muscle. The network 

of elastic fibers in the dermis was preserved. A diagnosis 

of pseudopelade of Brocq was made with clinicopatholog-

ical correlation: the patient had reduced hair density with 

a scarred background on the interparietal area, towards the 

vertex, with no signs of inflammation.

Teaching Point

Elastic stains like Verhoeff-van Giesson and orcein are 

part of an alopecia histopathological routine study and 

can aid in the differential diagnosis of scarring alopecias. 

 Elastic  fibers are characteristically preserved and thickened 

in central centrifugal cicatricial alopecia and pseudopelade 



2 Image Letter | Dermatol Pract Concept. 2023;13(2):e2023088

of Brocq, while other types of scarring alopecias like lupus 

 erythematosus or lichen planopilaris show loss or absence 

of elastic fibers [1,2]. Histology needs to be correlated with 

clinical history and examination. While the existence of 

pseudopelade of Brocq as an independent clinical entity is 

still under debate, it being a diagnosis of exclusion, some 

recent molecular studies have begun to shed light in its dis-

tinction from lichen planopilaris [1,2]. Further research is 

still needed to clear up this long-standing controversy.

References

1. Bernárdez C, Molina-Ruiz AM, Requena L. Histologic features 

of alopecias: Part II: Scarring alopecias. Actas Dermosifiliogr. 

2015;106(4):260-270. DOI:10.1016/j.ad.2014.06.016. PMID: 

25439143.

2. Ramos-e-Silva M, Pirmez R. Disorders of hair growth and the 

pilosebaceous unit: Facts and controversies. Clin Dermatol. 

2013;31(6):759-763. DOI:10.1016/j.clindermatol.2013.06.003. 

PMID: 24160282.

Figure 1. (A, B) Pseudopelade of Brocq: H-E x10 (A) and elastic stain-orcein x10 (B). The dermal elastic network is intact. Dense elastic 

fibers can be observed along a band of fibrous tissue which stretches below and above the preserved arrector pili muscle. Syringomatous 

hyperplasia can be observed (on the right).