Perifollicular Erythematous Papules on the Scalp

A 59-year-old white woman with hypothyroidism presented with a 4-year history of frontotemporal hairline recession and alopecia, which had progressed without regrowth. Physical examination showed scarring alopecia of the frontotemporal scalp and eyebrows, with a clear demarcation on the mid-forehead between sun-damaged and sun-protected skin. Closer examination revealed 1- to 2-mm perifollicular erythematous papules near areas of scarring alopecia. Biopsy specimens indicated a lymphocytic cicatricial alopecia with lichenoid lymphocytic interface folliculitis at the isthmus of the follicle. The document includes a multiple-choice question regarding the most likely diagnosis, the most effective first-line treatment, and the expected dermoscopic findings for the diagnosis, but does not provide the answers to these questions.