Case 6 Scarring alopecia of frontal hair line

    A 66 year old female with a past medical history of hypothyroidism presented with hair loss that had developed gradually over the past 2-3 years. She first noted thinning of the eyebrows followed by recession of her frontal hairline. Her eyebrow loss progressed, necessitating coverage with a tattoo. She also noted decreased hair growth on her arms, legs, and eyelashes.  

    Physical examination of the scalp revealed a receding hairline with decreased hair density on the frontotemporal scalp as compared to the occipital scalp. There were islands of scarring on the frontal scalp with obliteration of the follicular ostia. There was perifollicular erythema and scaling most prominent on the frontal scalp. Hair pull test was negative. There was complete absence of eyebrow hairs, and a brown tattoo covered the area. There was also decreased hair density of the eyelashes and extremities.