CENTRAL CENTRIFUGAL CICATRICIAL ALOPECIA
By Gary M. White, MD
The woman shown has severe CCCA with near total scalp involvement.
Central Centrifugal Cicatricial Alopecia (CCCA), also known as Follicular Degeneration Syndrome is the most common type of primary scarring alopecia in women of African descent.
- The age of onset is 30-65.
- It is often associated with traction alopecia.
- It can be inherited in an autosomal dominant fashion.
- Symptoms range from none to severe itching and pain.
- Patients with CCCA have an almost five times increased odds of uterine leiomyomas [JAMA Dermatology January 11, 2018].
Hair loss begins at the crown or vertex and spreads out centrifugally and symmetrically over time. Advanced cases show a smooth and shiny scalp. Erythema and inflammation are usually absent. Darker skinned women are preferentially affected.
Rarely CCCA may affect children [PD 2017;34;133]. In one review of 6 adolescents, the age range was 14-19 years, 4/6 were female and tender papules, pruritus and scaling were common in addition to the alopecia.
No good proven therapy yet exists.
In one study [JAAD April 2014], those women with a history of braiding or weaving their hair and use of chemicals to process the hair (relaxed or permed) had more severe disease. Thus, the admonition for the patient and any children is:
- No chemicals
- No traction, braids, etc.
- Short hair is better than long hair.
If there are symptoms such as itching and/or burning ala seborrheic dermatitis, use of medicated shampoo and a topical steroid may be prescribed.
Therapies that are being tried at various centers include:
- Topical and intralesional steroids. This may consist of triamcinolone 2.5-10 mg/cc every 4-6 weeks for a period of 6 months. The target should be the periphery where the condition is thought to be most active. The goal is to prevent further hair loss--not grow hair that has already been lost.
- Topical minoxidil.
- Various oral agents including tetracyclines, antimalarials, mycophenolate mofetil, anti-androgens, and/or 5-alpha-reductase inhibitors.
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