SKIN 
 

March 2019     Volume 3  Issue 2 
 

Copyright 2018 The National Society for Cutaneous Medicine 137 

RISING DERM STARS® 
 

 
Hairy Legs Revisited: Peroneal Alopecia 
 
Katherine Glaser MD1, Kenneth Tomecki MD 
 
1Department of Dermatology, Cleveland Clinic, Cleveland, OH 
 

 
 
Background/Objectives: Peroneal alopecia 
(PA), also called anterolateral leg alopecia, is 
a common, often underreported and 
understudied type of hair loss in middle-aged 
men. It presents as large sharply demarcated 
alopetic patches symmetrically over the 
anterolateral aspects of the legs, reflecting 
the distribution of the peroneal nerve. The 
underlying etiology is poorly understood. 
Suggested associations include friction from 
tight fitting clothing, androgenetic alopecia, 
thyroid disease, diabetes, and peripheral 
vascular disease. This study aims to review 
these reported associations in our subset of 
patients. 
 
Methods: We conducted a cross-sectional 
study in our outpatient dermatology clinic. 50 
consecutive men aged ≥ 50 years who 
presented for routine full body skin exams 
were included. Routine skin examination was 
performed including evaluation for 
androgenetic alopecia using the Norwood-
Hamilton scale. Medical history included 
inquiry of known diabetes, peripheral 
vascular disease or cardiac disease, and 
family history of androgenetic alopecia. We 
asked all patients if they wore tight fitting 
socks or clothing on a regular basis. 
 
Results: We detected PA in 42% of men 
(n=21). Personal and family history of 
androgenetic alopecia was common, 46% 
and 48% respectively. In patients with PA, 

androgenetic alopecia occurred in 57% 
(n=12) compared to the 37% (n=11) without 
PA. The prevalence of diabetes and vascular 
disease was comparable to the general 
population and occurred similarly in those 
with and without PA. Regular use of tight 
fitting socks was reported in only 5 patients 
with the majority (n=4) found to have PA, 
though these patients often hypothesized this 
to be the cause of their hair loss. (See table 
1) 
 
Limitations: Small sample size and the 
selected age cut-off may not capture the true 
prevalence of this entity. The study does not 
incorporate dermoscopy or histopathology 
which can be helpful in distinguishing types 
of alopecia. 
 
Conclusion: PA is an extremely common 
form of hair loss in middle-aged men. This 
study represents the largest study of PA to 
date. We failed to identify any clear 
correlation in this study though personal and 
family history of androgenetic alopecia was a 
common association. We plan to extend our 
study and examine such patients further to 
determine a statistically significant 
pathogenesis. 
 
 
 
 
 



SKIN 
 

March 2019     Volume 3  Issue 2 
 

Copyright 2018 The National Society for Cutaneous Medicine 138 

 
 
Table 1: Incidence of peroneal alopecia.  

 Present 
n=21 
(42%) 

Absent 
n=29 
(58%) 

Total 
n=50  

Androgenetic 
Alopecia 

12 (57) 11 (37) 23 
(46) 

FHx 
Androgenetic 

Alopecia 

13 (61) 11 (37) 24 
(48) 

Diabetes 4 (19) 3 (10) 7 
(14) 

Vascular 
Disease 

6 (29) 9 (31) 15 
(30) 

Tight Fitting 
Socks 

4 (19) 1 (3) 5 
(10) 

FHx, family history of 
 
 

References: 
1. Brueseke TJ, Macrino S, Miller JJ. Lack of 

lower extremity hair not a predictor for 
peripheral arterial disease. Arch 
Dermatol. 2009;145(12):1456-7 

2. Gupta SN, Shaw JC. Anterolateral leg 
alopecia revisited. Cutis 2002;70:215-6 

3. Jakhar D, Kaur I. Frictional (Sock) 
alopecia of the legs: Trichoscopy as an 
aid. Int J Trichol 2018;10:129-30 

4. Shetty VM, Pai SB, Pai K, Jenson JJ. 
Anterolateral leg alopecia: unknown 
entity or yet underreported? Int J 
Dermatol. 2018 Sep. [Epub ahead of 
print] PMID: 30264393 

5. Trueb RM, Lee WS. “Diagnosis and 
Treatment.” Male Alopecia: Guide to 
Successful Management. Springer 
International Pu, 2016, pp. 75–89