Central centrifugal cicatricial alopecia

Central Centrifugal Cicatricial Alopecia

Central centrifugal cicatricial alopecia (CCCA) is a type of scarring alopecia that primarily affects women of African descent. It is characterized by progressive hair loss that starts at the crown of the scalp and spreads outward in a centrifugal pattern. This condition leads to permanent hair loss due to the destruction of hair follicles and replacement with scar tissue.

Pathophysiology

The exact cause of CCCA is not fully understood, but it is believed to be multifactorial. Genetic predisposition, inflammation, and trauma to the hair follicles are considered contributing factors. The condition is associated with the use of certain hair care practices, such as the application of chemical relaxers, heat styling, and tight hairstyles that cause traction on the hair.

Histologically, CCCA is characterized by the presence of inflammatory cells around the hair follicles, leading to their destruction and subsequent scarring. The inflammation is primarily lymphocytic, and over time, the affected areas of the scalp show a reduction in the number of hair follicles and an increase in fibrous tissue.

Clinical Presentation

Patients with CCCA typically present with hair loss at the vertex of the scalp, which gradually expands in a centrifugal pattern. The hair loss is often accompanied by symptoms such as itching, tenderness, and a burning sensation in the affected area. The scalp may appear shiny due to the presence of scar tissue.

The condition is most commonly seen in middle-aged women of African descent, but it can also occur in men and individuals of other ethnicities. The progression of hair loss can vary, with some patients experiencing rapid progression and others having a more indolent course.

Diagnosis

The diagnosis of CCCA is primarily clinical, based on the characteristic pattern of hair loss and patient history. A scalp biopsy may be performed to confirm the diagnosis and rule out other causes of scarring alopecia. The biopsy typically shows perifollicular fibrosis and a reduction in the number of hair follicles.

Management

The management of CCCA involves halting the progression of hair loss and alleviating symptoms. Treatment options include:

• Topical and intralesional corticosteroids to reduce inflammation.
• Antibiotics such as doxycycline, which have anti-inflammatory properties.
• Hydroxychloroquine, an antimalarial drug with anti-inflammatory effects.
• Avoidance of hair care practices that may exacerbate the condition, such as chemical relaxers and tight hairstyles.

In advanced cases, surgical options such as hair transplantation may be considered, although the success of such procedures can be limited by the extent of scarring.

Prognosis

The prognosis of CCCA varies depending on the stage at which treatment is initiated. Early intervention can help prevent further hair loss and manage symptoms, but once scarring has occurred, the hair loss is permanent. Regular follow-up with a dermatologist is recommended to monitor the condition and adjust treatment as needed.

Related Pages

• Alopecia
• Scarring alopecia
• Traction alopecia
• Lichen planopilaris