Systemic sarcoidosis presenting with alopecia of the scalp

A 39‐year‐old African‐American woman was referred to the department of dermatology, Mount Sinal Hospital, New York for evaluation of a skin lesion on her scalp which had been present for 3 years and had recently changed in appearance. On examination, she was found to have erythematous plaques with hair loss extending from the frontal hairline on the right side in a “C‐shaped” distribution, terminating behind the left ear. Two years later the lesion had rapidly extended to the vertex of the scalp and left temporal area ( Fig. 1 ). There was a 10 cm × 12 cm area of alopecia at the vertex with slight erythema, but there was no evidence of scarring, inflammation or nodularity of the scalp ( Fig. 2 ). A skin biopsy taken from the forehead revealed granulomatous dermatitis showing noncaseating granuloma with negative acid fast bacilli (AFBC) and ammonical‐silverstain for fungus (GMS) ( Fig. 3 ).

Figure 1 Open in figure viewer PowerPoint Erythematous plaque with hair loss on the left temporal area