Increased Preauricular Wrinkles in Frontal Fibrosing Alopecia Compared to Age-Matched Controls: A Prospective Study of 64 Patients

Abstract

Introduction: Frontal fibrosing alopecia (FFA) is a scarring alopecia affecting mainly postmenopausal females. Associated clinical signs include facial papules, glabellar red dots, depression of frontal veins, and lichen planus pigmentosus. Our objective was to establish the validity of increased preauricular lines as another clinical marker of FFA. Materials and Methods: Thirty-two females with FFA were compared to 32 age-matched females with either androgenetic alopecia or chronic telogen effluvium. Bilateral images of the preauricular area were taken, and disease severity was calculated in all FFA patients using the FFA severity scale (FFASS). The average number of preauricular lines were determined and compared based on group, age, and severity. Results: Patients with FFA had a significantly higher mean number of preauricular lines than controls (p = 0.002). Intergroup analysis among the FFA patients revealed no significant difference between FFASS and the number of wrinkles or the number of wrinkles in patients ≥60 years old. Discussion and Conclusion: Females with FFA have increased preauricular lines compared to age-matched controls regardless of age, and disease severity was not correlated to increased lines. Although the cause is unknown, atrophy and loss of elastic fibers in biopsies of the preauricular area in diseased patients may contribute. These findings reveal another potential clinical marker of FFA.