Central Centrifugal Cicatricial Alopecia

Central Centrifugal Cicatricial Alopecia

Scarring hair loss results when an inflammatory skin condition destroys the hair follicle and replaces it with a scar. Central centrifugal cicatricial alopecia (CCCA) is a common cause of cicatricial or scarring hair loss in black women. This form of hair loss includes conditions previously known as “hot comb alopecia,” “follicular degeneration syndrome,” or “pseudopelade.” CCCA is the most common type of cicatricial hair loss. While most common in black women, it can occur in any race or either sex.

Symptoms

Central centrifugal cicatricial alopecia (CCCA) most commonly begins on the crown or vertex of the scalp gradually expanding outward in a centrifugal fashion. As the process progresses, initial areas of involvement become smooth and shiny where the hair follicles have been permanently damaged. A few short and brittle hairs often remain within the area of scarring. Symptoms associated with this condition are generally mild and include itching, burning, tingling, and tenderness.

Causes and Risk Factors

Certain hair care practices such as hair weaving, excessive tension from braiding and long term chemical relaxer use have been associated with an increased risk of developing CCCA. However, there is new evidence that family history may play a role in this condition.

Diagnosis and Treatment

Dermatologists will often suspect CCCA based on the examination of your scalp, however, a skin biopsy is usually necessary to confirm the diagnosis. A biopsy is the removal of a small piece of scalp skin for examination under a microscope. A dermatologist can quickly and safely perform a biopsy during an office visit.

Treatment options are limited once scarring occurs; therefore, it is best to treat this condition early. Hairstyles requiring heat treatment or traction and pulling of the hair should be avoided. The use of relaxers should also be discontinued. Treatments can include anti-inflammatory medications such as topical, injected or oral corticosteroids and oral antibiotics such as doxycycline or other tetracyclines. Topical minoxidil has been used to help stimulate hair growth from follicles that have not yet scarred. While hair transplantation can be considered, the presence of scarring may decrease the chance of survival of the transplanted hair follicle.

Management

CCCA generally progresses slowly but longstanding involvement can result in permanent hair loss covering the entire crown of the scalp. Cosmetic aids such as tinted powders, lotions, and hair fiber sprays can all provide camouflage in areas of hair loss. Wigs and hairpieces can be used to cover balding areas. Advances in the technology of these have made their use more acceptable.

The emotional aspects of living with hair loss can be significant. Joining a support group such as the Cicatricial Alopecia Research Foundation may help one to cope with scarring hair loss.

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Central Centrifugal Cicatricial Alopecia

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