Facial Papules Are Early Sign of Frontal Fibrosing Alopecia: A Cross-Sectional Study

  • Parvin Mansouri ORCID Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • Masoumeh Rohani Nasab ORCID Department of Dermatology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
  • Zahra Safaei Naraghi ORCID Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
  • Safoura Shakoei ORCID Mail Department of Dermatology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  • Reza Chalangari Kassir Dermatology, Dallas, Texas, USA
  • Katalin Martits –Chalangari ORCID Kassir Dermatology, Dallas, Texas, USA
  • Mohammad Reza Rahbar ORCID Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
Lichen planus follicularis, Lichen plan, Facial papules, Frontal fibrosing alopecia


Frontal fibrosing alopecia (FFA), a form of lichen planopilaris (LPP), is primary cicatricial alopecia commonly affecting postmenopausal women. For the first time, we investigated the diagnosis of FFA and LPP in patients presenting with the chief complaint of facial papules and roughness. This cross-sectional was performed among 68 patients with facial papules. We described the epidemiology, comorbidities, clinical presentations, and the association between facial papules and LPP or FFA. All the patients were female with a mean age of 47.84 years. Scalp alopecia was observed in all the patients presenting with facial papules, of which 89.7% had FFA. Five patients were diagnosed with LPP without FFA. Most of the patients were premenopausal (73.5%), and 70.6% had grade I FFA. Concomitant cutaneous lichen planus involvement was observed more frequently than mucosal involvement. The most frequent comorbidities were hypothyroidism, dyslipidemia, and hypertension. History of alopecia areata was detected in 8.8% of the patients. Androgenetic alopecia (AGA) was present in 17 patients (25%). Facial papules are the silent and early signs of FFA and LPP.  Paying attention to these early signs along with metabolic disturbances can help with the early diagnosis of the disease, especially among premenopausal women.


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How to Cite
Mansouri P, Rohani Nasab M, Safaei Naraghi Z, Shakoei S, Chalangari R, Martits –Chalangari K, Rahbar MR. Facial Papules Are Early Sign of Frontal Fibrosing Alopecia: A Cross-Sectional Study. Acta Med Iran. 58(6):285-290.