Scarring alopecia in a woman with psoriasis

A 57-year-old African American woman came to our dermatology clinic to reestablish care. She had a long history of plaque psoriasis involving her trunk and extremities. More recently, she had developed progressive hair loss, which her previous physician had attributed to the psoriasis. Before this visit, our patient had been treating her psoriasis with topical clobetasol and calcipotriene.

A physical exam revealed multiple welldemarcated, erythematous, scaly plaques consistent with plaque psoriasis on her trunk and extremities. She also said her scalp was itchy, and we noted significant cicatricial (scarring) alopecia of the scalp, with faint perifollicular erythema, that was predominantly affecting the frontotemporal region (FIGURE). We performed a scalp biopsy.

WHAT IS YOUR DIAGNOSIS?
HOW WOULD YOU TREAT THIS PATIENT?