Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 6 2020 08 23 285 290 Parvin Mansouri Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran Masoumeh Rohani Nasab Department of Dermatology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Zahra Safaei Naraghi Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran Safoura Shakoei Department of Dermatology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Reza Chalangari Kassir Dermatology, Dallas, Texas, USA Katalin Martits –Chalangari Kassir Dermatology, Dallas, Texas, USA Mohammad Reza Rahbar Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran 2020 01 14 2020 05 02 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. https://acta.tums.ac.ir/index.php/acta/article/view/8278 https://acta.tums.ac.ir/index.php/acta/article/download/8278/5414