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  • Presentation

Medical Treatment of CCCA (Central Centrifugal Cicatricial Alopecia)

Description

The presentation discusses the medical treatment of Central Centrifugal Cicatricial Alopecia (CCCA), emphasizing the importance of accurate diagnosis as misdiagnosis significantly affects treatment outcomes. The speaker advocates for understanding differential diagnoses with better prognoses than CCCA. Medical therapies aim to address both inflammation and fibrosis associated with the condition. Notably, CCCA shows minimal inflammation compared to other scarring alopecias, complicating treatment strategies. Emphasis is placed on the development of a disease activity scale to guide treatment decisions and follow-ups, alongside an exploration of various therapies including high potency topical steroids, intralesional steroid injections, doxycycline, and metformin. The speaker suggests combining topical metformin with standard treatments to improve efficacy and discusses the role of oral metformin in reducing fibrosis. The presentation also highlights the importance of recognizing CCCA mimickers, where misdiagnosis can lead to ineffective treatments, as seen in patients with conditions like acquired trichorexis or traction alopecia. The definition of appropriate hair care practices for patients with curly and tightly coiled hair is underscored, particularly in terms of avoiding further damage. The talk wraps up with a cautionary note on the potential for differentiating CCCA from other types of alopecia, emphasizing the need for careful evaluation and treatment tailored to individual patient circumstances.

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Conclusions

  • Achieving hair regrowth in 25% of patients diagnosed with central centrifugal cicatricial alopecia (CCCA) is possible.
  • Misdiagnosis is a significant challenge in the treatment of CCCA.
  • Medical therapies for CCCA should target both inflammation and fibrosis.
  • Histologic features of CCCA may overlap with other forms of scarring alopecia, complicating diagnosis.
  • Fibroproliferative disorders are characterized by persistent low-grade inflammation leading to fibrosis, with increased risk in individuals of African descent.
  • A comprehensive clinical evaluation scoring system can help assess disease progression in CCCA patients.
  • Topical treatments including high-potency steroids, metformin, and compounded minoxidil can be effective for CCCA.
  • Doxycycline has dual anti-inflammatory and antifibrotic properties beneficial for scarring alopecia treatment.
  • Oral metformin may help reduce fibrosis and improve hair regrowth in CCCA through AMPK signaling.
  • Acquired trichorrhexis nodosa (ATN) can mimic CCCA, highlighting the importance of accurate diagnosis and hair care routines.
  • Some patients experience significant hair improvement from hair care adjustments without pharmacological interventions.
  • Traction alopecia can appear similar to CCCA, particularly in individuals with dreadlocks.
  • Healthy hair care practices can contribute to recovery from hair loss conditions, including CCCA and ATN.
  • Tan T, Guitart J, Gerami P, Yazdan P. Premature desquamation of the inner root sheath in noninflamed hair follicles as a specific marker for central centrifugal cicatricial alopecia. The American Journal of Dermatopathology. 2019 May 1:41 (5):350-4.
  • Moore AL, Duoto BA, Mascharak S, Murphy MP, Irizarry DM, Foster DS, Jones RE, Barnes LA, Marshall CD, Ransom RC, G. Doxycycline reduces scar thickness and improves collagen architecture. Annals of surgery. 2020 Jul;272(1):183.
  • Kim HS, Luo L, Pflugfelder SC, Li DQ. Doxycycline inhibits TGF-B1-induced MMP-9 via Smad and MAPK pathways in human corneal epithelial cells. Investigative ophthalmology & visual science. 2005 Mar 1;46(3):840-8.
  • Aguh C, Dina Y, Talbot Jr CC, Garza L. Fibroproliferative genes are preferentially expressed in central centrifugal cicatricial alopecia. Journal of the American Academy of Dermatology.
  • Araoye EF, Thomas JA, Aguh CU. Hair regrowth in 2 patients with recalcitrant central centrifugal cicatricial alopecia after use of topical metformin. JAAD Case Reports. 2020 Feb 1;6(2):106-8.
  • Loussouarn G, Garcel AL, Lozano I, Collaudin C, Porter C, Panhard S, Saint-Léger D, De La Mettrie R. Worldwide diversity of hair curliness: a new method of assessment. International journal of dermatology. 2007.