A Receding Hairline
A 58-year-old woman presented with a 2-year history of progressive hair loss involving the frontal hairline and eyebrows. She had a band of frontoparietal hairline recession and almost complete loss of eyebrows. The alopecic area could be distinguished from the unaffected forehead because the former showed no signs of photoaging (Panel A). Dermatoscopic examination revealed a loss of follicular openings on the alopecic band, the absence of vellus hairs, and perifollicular erythema and scales around the remaining terminal hairs on the “new” hairline (Panel B). A 4-mm biopsy specimen of the scalp showed loss of follicles and lichenoid lymphocytic infiltrate at the outer root sheaths of upper follicles (Panel C). A diagnosis of frontal fibrosing alopecia was made. This condition is a cicatricial alopecia that almost exclusively affects postmenopausal women, causing hairline recession and loss of eyebrows. Oral hydroxychloroquine and topical glucocorticoids were prescribed, and the disease has stabilized.