A 53-year-old white woman presents to the dermatology clinic for a refill on her ketoconazole 2% shampoo. About 1 year ago, her primary care provider had prescribed this antifungal shampoo for treatment of a pruritic, balding, tender area on her posterior scalp. The area has not improved since she started using the shampoo, but it also has not worsened.
The physical examination reveals foci of scarring alopecia with perifollicular erythema and scaling at the vertex (see Figure 1). Polytrichia, or tufting of the hair, is also noted. Scrapings for a potassium hydroxide (KOH) test and fungal culture are obtained, and the results of these tests are negative. Two 4-mm punch biopsy specimens are obtained and submitted to a dermatopathologist for vertical and horizontal sections to establish a definitive diagnosis.
The correct diagnosis is
- Tinea capitis
- Lichen planopilaris
- Discoid lupus erythematosus
- Alopecia areata
- Graham Little syndrome