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Exam revealed four asymptomatic well-circumscribed waxy tan dermal nodules with central atrophy and prominent overlying superficial telangiectasias scattered along his scalp measuring between 0.9 and 2.6 cm (Figure 1). In summary, ANL should enter diagnostic consideration for patients presenting with dermal atrophic nodules or arcuate plaques of the scalp. An 85-year-old well-appearing Caucasian gentleman with high blood pressure and hypercholesterolemia presented to clinic for his routine annual skin check. [Extracted from the article]

The isolated plaque being hypoesthetic with sloping margins made us suspect leprosy; however, the unusual presentation of alopecia considering the fact that leprosy usually spares warm, vascular areas like scalp also compelled us to consider other close differentials like sarcoidosis, discoid lupus erythematosus (DLE), alopecia mucinosa, and morphea. There have been less than 10 reports of paucibacillary leprosy involving the scalp, out of which three also had patchy alopecia.[[2], [4]] Alopecia can be a presentation of leprosy and should be considered as a differential in endemic areas with such unusual presentations. A 35-year-old female presented with a single edematous area of hair loss over the left side of the scalp since 6 months. [Extracted from the article]

Three years later, she returned having continued the hydroxychloroquine therapy for 10 months; she reported that while her pruritus and pain were diminished on the therapy, the frequency of the rash was unaffected and lesions typically recurred in the same locations. These histologic findings in the setting of a figurate erythema supported the diagnosis of chronic recurrent annular neutrophilic dermatosis (CRAND). A woman in her 50s presented with a 1-month history of a painful and pruritic eruption on her lower legs and right upper arm. [Extracted from the article]

The article focuses on a study related to sarcoidosis of the scalp. Topics discussed include histopathological demonstration of noncaseating granulomatous inflammation together with suggestive clinical and radiological features; pattern of scalp involvement ranged from annular plaques; and treatment of patients with chloroquine.