A 39-year-old woman with a history of alopecia areata presents for evaluation
of multiple macules and patches on her left mandibular face. She developed
these lesions slowly over several years, where they have remained stable for
many years. The patient’s goal now is to achieve repigmentation of the lesions.
The patient has previously used topical hydrocortisone 1% cream on the
lesions twice daily for the last 3 months with no improvement. Which of the
following is the most appropriate next step in the management of the patient?
A. Initiation of narrowband UVB light therapy
B. Perform fungal scraping for KOH examination
C. Referral for suction blister epidermal grafting
D. Repeat three-month trial of hydrocortisone 1% cream
E. Trial of potent topical corticosteroid
