Progressive hair loss
A specific hair-loss pattern and the patient’s age and gender pointed to the diagnosis.
A 66-year-old white woman presented to her primary care clinic with concerns about hair loss, which began 2 years ago. Recently, she had noticed some “bumps” on her cheeks, as well.
On physical examination, the physician noted hair loss in a symmetric 2-cm band-like distribution across her frontal and temporal scalp (FIGURES 1 and 2). In both areas, there was moderate perifollicular erythema, scale, and what appeared to be scarring.
The patient had lost most of her eyebrow hairs, and had prominent temporal veins (FIGURE 2) and flesh-colored papules on her cheeks. She had no significant medical history, was emotionally stable, and recently had a satisfactory health care maintenance exam. The postmenopausal patient’s last menses was 15 years earlier, and she was not taking hormone replacement.
