CENTRAL CENTRIFUGAL CICATRICIAL ALOPECIA

Central Centrifugal Cicatricial Alopecia (CCCA), also known as Follicular Degeneration Syndrome (FDS) is the most common type of primary scarring alopecia in women of African descent.

• A recent study touted the benefit of topical metformin, 10% cream daily. Oral metformin may be considered in patients with elevated HbA1C.
• Patients with CCCA have an almost five times increased odds of uterine fibroids and 2.6 times the incidence of breast cancer.
• Vitamin D deficiency was much more common compared to patients with alopecia areata with an odds ratio of 2.6.
• 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.

Clinical

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.

Dermoscopy

Trichoscopy of CCCA shows a peripilar gray-white halo, which is a sensitive sign for the diagnosis of CCCA. This corresponds on histopathology to the outer root sheath of the affected follicles with a surrounding zone of lamellar perifollicular fibrosis

Pediatric Cases

Rarely CCCA may affect children. 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.

How to Diagnose

One may consider biopsy if traction alopecia, androgenetic alopecia, lichen planopilaris or folliculitis decalvans are being considered. Remember that patients may have more than one diagnosis. For example, patterned alopecia will affect many patients with another form of alopecia, e.g. CCCA.

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