This healthy 9-year-old girl had an itchy scaly patch on her mid frontal scalp a year ago which was treated with topical steroids. The patch improved but hair loss slowly progressed. She subsequently developed several scaly patches on her forehead and left temple which also improved but never cleared with topical steroids. On evaluation a potassium hydroxide preparation was florridly positive from hair bearing (endothrix)as well as non-hair bearing (septate branching hyphae) areas. She was started on oral ultramicrosized griseofulvin. Note the annular patch on the left temple.
scaly hypopigmented 3 cm patch with decreased hair density; subtle scaly annular patch on the left temple