Patchy alopecia with pubic and axillary hair loss

A 48-year-old female presented with a unique presentation of alopecia in a sisaipho-like pattern (Fig 1), accompanied by hair loss of the axillary and pubic regions, and multiple perifollicular keratotic papules on the abdomen (Fig 2). The patient had been experiencing these symptoms for nearly 10 years, along with severe pruritus and scaling around the hair follicles on her scalp. She reported no family history or any comorbid diseases. Laboratory tests, including autoimmune antibody panels, immunoglobulin levels, and thyroid function tests, were all within normal limits.