An elderly woman with a recessing hairline

A 71-year-old woman gave an 18-month history of progressive recession of the frontal hairline associated with loss of her eyebrows (Figure 1). The process had commenced suddenly and was asymptomatic. Close examination of the scalp margin revealed loss of follicular orifices and a smooth pale skin. The anterior hairline had follicles associated with perifollicular erythema and slight scaling at their openings. Scalp biopsy showed a decreased number of hair follicles. There was prominent perifollicular fibrosis and lymphocytic inflammation targeting several remaining follicles (Figure 2).