A 49-year-old black woman presented with a 4-month history of new-onset diffuse scalp bogginess and irregularity. She first noticed gradual swelling of her scalp and slowed hair growth, with a few areas of frontal thinning. The swelling progressed to involve her entire scalp and was accompanied by a "crawly, wormlike" sensation but no pruritus or pain. During the 4-month period, she had been otherwise well. She reported no history of trauma, no new medications, and no accompanying systemic symptoms.