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Erythematous Papules Involving the Eyebrows in a Patient with a History of Rosacea and Hair Loss

A 47-year-old woman presented with a 2-year history of hair loss and rosacea. She had been treated with topical metronidazole without improvement. Clinical examination revealed very sparse eyebrows and grouped small erythematous papules on the top of her eyebrows bilaterally (Fig. 1a). She had prominent telangiectasias of the cheeks and temporal hairline recession. A dermoscopyguided 2-mm biopsy (Fig. 1b) from an erythematous papule showed a dilated follicular infundibulum, and some surrounding lymphocytes with focal vacuolization of the follicular epithelial basalis without significant perifollicular fibrosis (Fig. 2a). Some demodex material was identified within the follicular ostia. Large sebaceous lobules were present in the central, subjacent dermis with associated adnexal glands (Fig. 2b). What is your diagnosis?