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  • Presentation

Central Centrifugal Cicatricial Alopecia (CCCA): Pathogenesis and Treatment

Description

Central Centrifugal Cicatricial Alopecia (CCCA) primarily affects Black women with afro-textured hair and is characterized by hair loss, especially on the vertex of the scalp. The exact prevalence is uncertain but ranges from 2.7% to 5.6%. CCCA is mainly considered a fibrosing process rather than an inflammatory one, with genetic factors and unique hair structure contributing to its development. Diagnosis involves clinical evaluation, dermoscopy, and potentially scalp biopsies to differentiate it from other types of alopecia. Treatment approaches recommended include high-potency topical steroids and adjunct therapies like oral doxycycline and minoxidil, with evidence suggesting a role for metformin as an antifibrotic option. Research indicates a significant correlation between CCCA and conditions like uterine fibroids, diabetes, and breast cancer. Overall, a multidisciplinary approach that considers patient demographics and unique hair care practices is essential for effective management.

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Conclusions

  • Central centrifugal cicatricial alopecia (CCCA) is a prevalent form of scarring alopecia primarily affecting Black women with afro-textured hair.
  • The prevalence of CCCA among women of African ancestry ranges from 2.7% to 5.6%.
  • CCCA is characterized by a decrease in hair density on the vertex scalp, and hair loss can often be irreversible.
  • Genetic factors, including mutations in the PADI3 gene, contribute to CCCA pathology.
  • CCCA is influenced by a combination of genetic susceptibility, hair texture differences, and grooming practices.
  • Patients with CCCA have a significantly higher incidence of uterine fibroids and associated comorbidities such as diabetes and breast cancer.
  • Doxyclycline, topical steroids, and minoxidil are effective treatments for CCCA, and should be considered in combination for optimal results.
  • Antifibrotic treatments like metformin may reduce fibrotic processes associated with CCCA and improve hair regrowth in affected patients.
  • Early signs of hair breakage can indicate the onset of CCCA and should be monitored closely.
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