Cicatricial Centrifugal Alopecia

Cicatricial Centrifugal Alopecia, also known as Central Centrifugal Cicatricial Alopecia (CCCA), primarily affects individuals of African descent. It is more common among women, particularly those with a history of tight hairstyles, chemical treatments, or heat styling. However, it can also occur in men.

CCCA tends to develop in adulthood, typically between the ages of 25 and 65. It is important to note that while CCCA predominantly affects individuals of African descent, it can also occur in individuals from other racial and ethnic backgrounds.

What is Central Cicatricial Centrifugal Alopecia?

Central Cicatricial Centrifugal Alopecia is a distinct type of scarring alopecia, a group of hair loss conditions that cause permanent damage to the hair follicles. Unlike other forms of alopecia, CCA is characterized by a specific pattern of progressive hair loss, which usually starts at the crown of the head and gradually moves outward in a circular pattern - hence the term 'centrifugal.' This progressive nature and irreversible damage to the hair follicle make it critical to understand and address CCA promptly.

The Causes of Cicatricial Centrifugal Alopecia

As of now, the exact causes behind CCCA remain relatively elusive. It is believed to be primarily an inflammatory condition but seems related to several other internal and external factors.

1. Inflammatory Condition: CCCA is primarily considered an inflammatory disease, where the immune system mistakenly targets specific hair follicles, causing inflammation and leading to hair loss.
2. Genetic Factors: There is growing evidence that genetics play a role in susceptibility to CCCA. Changes in the PADI3 gene have been linked to about 25% of cases.
3. Hair Styling Practices: The condition has been associated with specific hair styling methods, including the use of heat (hot combs, hair straighteners, dryers, curling irons), traction (tight braids, cornrows, weaves, ponytails, hair extensions), and chemical relaxers, especially those containing lye.
4. Association with Type 2 Diabetes: Several studies have indicated a correlation between type 2 diabetes and hair loss, potentially relevant to CCCA.

Recognizing the Symptoms of CCCA

The primary symptom of CCCA is progressive hair loss starting from the crown and moving outward. This process is usually slow and can take several years to become noticeable. Other symptoms may include:

• Redness or inflammation in the affected area
• Burning or itching sensation
• Tenderness or pain at the site of hair loss

Unlike non-scarring forms of alopecia, CCCA can lead to permanent hair loss, as the inflammatory process destroys the hair follicle entirely.

Diagnosis and Treatment of CCCA

How to diagnose Central Cicatricial Centrifugal Alopecia (CCCA)

It is essential to consult a dermatologist for an accurate diagnosis of CCCA. They will be able to evaluate your specific symptoms and conduct the necessary tests to confirm the condition and develop an appropriate treatment plan. The diagnosis of Central Cicatricial Centrifugal Alopecia (CCCA) typically involves a combination of clinical evaluation, medical history assessment, and specific tests. Here are the steps involved in diagnosing CCCA:

1. Medical History: The doctor will begin by taking a detailed medical history, including information about symptoms, duration of hair loss, previous hair treatments, family history of hair loss, and any underlying medical conditions.
2. Physical Examination: A thorough examination of the scalp will be conducted to assess the pattern and extent of hair loss, as well as to look for signs of inflammation, scarring, or other characteristic features of CCCA.
3. Scalp Biopsy: A scalp biopsy is often performed to confirm the diagnosis. During this procedure, a small sample of the affected scalp tissue is taken and examined under a microscope to assess the presence of inflammation, scarring, and other specific features associated with CCCA.
4. Blood Tests: In some cases, blood tests may be ordered to rule out other potential causes of hair loss and to evaluate for any underlying medical conditions contributing to CCCA.
5. Dermoscopy: Dermoscopy, also known as scalp microscopy, may be used to examine the scalp in detail. This non-invasive technique allows the doctor to visualize the hair follicles and assess any specific features that aid in diagnosing CCCA.

Possible treatments for Central Cicatricial Centrifugal Alopecia (CCCA)

The treatment options for Central Cicatricial Centrifugal Alopecia (CCCA) aim to manage the condition and slow down its progression. While there is no known cure for CCCA, the following treatments may be considered:

1. Topical Steroids: Corticosteroid creams or ointments can be applied to the affected areas of the scalp to reduce inflammation and halt further hair loss.
2. Intralesional Steroid Injections: Steroid injections are directly administered into the affected areas of the scalp to reduce inflammation and promote hair regrowth.
3. Antibiotics: In cases where CCCA is associated with a bacterial infection, oral or topical antibiotics may be prescribed to address the underlying infection.
4. Topical Immunotherapy: This treatment involves applying a sensitizing agent, such as diphencyprone (DPCP), to stimulate an immune response and promote hair regrowth.
5. Systemic Medications: Oral medications, such as hydroxychloroquine or ciclosporin, may be prescribed in some instances to control inflammation and halt the progression of CCCA.

Treatments for Central Cicatricial Centrifugal Alopecia (CCCA) - New studies

A recent study on patients with treatment-refractory Central Centrifugal Cicatricial Alopecia (CCCA) found that low-dose oral metformin (500 mg once daily) led to significant improvements. After at least 6 months of treatment, 9 out of 12 participants reported reduced scalp pain, inflammation, and itching, while 6 showed clinical evidence of hair regrowth. Transcriptomic analysis in 4 patients revealed upregulation of keratin-associated proteins (KRTAPs) involved in hair growth and downregulation of fibrosis-related genes like MMP7 and COL6A1. These findings highlight metformin’s potential to stimulate hair regrowth and reduce fibrosis in CCCA.

Cicatricial Centrifugal Alopecia vs. female pattern genetic and age-related hair loss?

Cicatricial Centrifugal Alopecia (CCA) is a scarring alopecia characterized by progressive and irreversible hair loss that starts at the crown and moves outward in a circular pattern. It primarily affects individuals of African descent and can result in permanent hair loss due to the inflammatory process damaging the hair follicles.

On the other hand, common female pattern hair loss (CFPHL) is a non-scarring alopecia that occurs in women and is characterized by the gradual thinning of hair in a diffuse pattern over the top of the scalp. Unlike CCA, CFPHL does not cause scarring or inflammation, and hair loss is typically not permanent.

While both conditions involve hair loss, CCCA is associated with scarring and inflammation, leading to permanent hair loss. At the same time, CFPHL is non-scarring and does not typically result in complete hair loss.

Cicatricial Centrifugal Alopecia vs. Frontal Fibrosing Alopecia (FFA)

Cicatricial Centrifugal Alopecia (CCA) and Frontal Fibrosing Alopecia (FFA) are both forms of scarring alopecia but affect different areas of the scalp.

CCA primarily involves progressive and irreversible hair loss that starts at the crown of the head and moves outward in a circular pattern. It is commonly seen in individuals of African descent and can lead to permanent hair loss due to scarring and inflammation.

On the other hand, FFA specifically affects the frontal hairline and the front part of the scalp. It is characterized by a band-like pattern of hair loss, including the loss of eyebrows. FFA predominantly occurs in postmenopausal women and is also associated with scarring and inflammation, which can result in permanent hair loss.

While both conditions share similarities as scarring alopecia with inflammatory components, their distinctive patterns of hair loss and affected areas differentiate them.

FAQs

Q1. What is Cicatricial Centrifugal Alopecia?
A1. Cicatricial Centrifugal Alopecia (CCA) is a scarring alopecia that causes progressive and irreversible hair loss in a circular pattern from the crown of the head outward.

Q2. Who does Cicatricial Centrifugal Alopecia primarily affect?
A2. CCA primarily affects individuals of African descent, especially women with a history of tight hairstyles, chemical treatments, or heat styling.

Q3. At what age does Cicatricial Centrifugal Alopecia typically develop?
A3. CCA tends to develop in adulthood, typically between the ages of 25 and 65.

Q4. Can Cicatricial Centrifugal Alopecia occur in individuals from other racial and ethnic backgrounds?
A4. While CCCA predominantly affects individuals of African descent, it can also occur in individuals from other racial and ethnic backgrounds.

Q5. What causes Cicatricial Centrifugal Alopecia?
A5. The exact causes of CCA are still unknown, but it is believed to be primarily an inflammatory condition, with the immune system mistakenly attacking the hair follicles.

Q6. What are the symptoms of Cicatricial Centrifugal Alopecia?
A6. Symptoms of CCA include progressive hair loss starting from the crown, redness or inflammation in the affected area, a burning or itching sensation, and tenderness or pain at the site of hair loss.

Q7. How is Cicatricial Centrifugal Alopecia diagnosed?
A7. Diagnosis of CCA involves a thorough medical history assessment, physical examination of the scalp, scalp biopsy to confirm the diagnosis, and sometimes blood tests or dermoscopy.

Q8. Is there a cure for Cicatricial Centrifugal Alopecia?
A8. There is no known cure for CCA, but treatments are available to manage the condition and slow its progression.

Q9. What treatments are available for Cicatricial Centrifugal Alopecia?
A9. Treatment options for CCA include topical steroids, intralesional steroid injections, antibiotics for associated infections, topical immunotherapy, and systemic medications like hydroxychloroquine or doxycycline.

Q10. Can Cicatricial Centrifugal Alopecia cause permanent hair loss?
A10. Yes, CCA can lead to permanent hair loss as the inflammatory process destroys the hair follicle entirely.

Conclusion

While Cicatricial Centrifugal Alopecia (CCA) may not be as well-known as other forms of hair loss, its potential to cause permanent hair loss makes it essential to understand. Recognizing the symptoms early, seeking an appropriate diagnosis, and initiating prompt treatment can significantly impact the progression of this condition. By equipping ourselves with knowledge and understanding, we can demystify CCA and provide empathy and support to those affected. The world of hair loss is vast and varied, and each discovery, like CCA, brings us one step closer to fully understanding this complex issue.

Remember, if you or someone you know is experiencing signs of CCA, don't hesitate to reach out to a dermatologist. After all, it's not just about hair; it's about health, self-esteem, and living life confidently.

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