Central Centrifugal Cicatricial Alopecia

What is Central Centrifugal Cicatricial Alopecia (CCCA)?

Hair loss is a common complaint for African American women. Numerous studies have shown that certain scalp disorders are more common in African Americans, especially African American women. Central Centrifugal Cicatricial Alopecia (CCCA) is a progressive and dramatic form of scarring alopecia that occurs almost exclusively in African American women. It is unusual for men to develop CCCA.

What is the age of onset of CCCA?

The onset of CCCA is very slow, typically developing over the course of years. Patients usually present with thinning and balding of the scalp in their second to fourth decade of life. The characteristic patient is a middle-aged woman of African descent.

What does CCCA look like?

CCCA starts near the vertex or top of the scalp and spreads in an outward direction. As the process develops, the entire scalp may become involved in the balding process. The involved area is usually smooth and shiny with decreased hair density. The remaining hairs within the area of scarring are dry and brittle.

What are the symptoms of CCCA?

Some patients may experience symptoms such as itching, burning, and pain in the involved areas, while other patients are completely asymptomatic.

What is the cause of CCCA?

The exact cause of CCCA is poorly understood. Certain factors have been implicated in the development of CCCA including, thermal straightening (blow drying and curling irons), traction or excessive tension on the hair, chemical straightening (relaxers), and infection. However, there is no conclusive evidence proving a direct causative relationship between any of these factors and CCCA.

How is CCCA treated?

Presently, there is no consistently successful treatment for CCCA.

Treatments that have been tried include:

  • Alteration of hair grooming practices. Avoidance of hairstyles that produce tension or pulling of the hair is paramount.  Patients should be advised to stay way from tight braids, heavy extensions. The frequency of chemical relaxers should be decreased to every eight to ten weeks. Patients should be encouraged to experiment with chemical-free natural hair styles
  • Topical anti-inflammatory agents: topical corticosteroids, pimecrolimus, a tacrolimus may be applied to the scalp to help reduce inflammation
  • Intralesional steroids: monthly injections at the edge of scarring may help to reduce the scarring
  • Oral antibiotics: oral antibiotics such as tetracycline may be used for both their anti-inflammatory and anti-biotic effects
  • Minoxidil: topical minoxidil – either the 2% and 5% solution/foam may be used to stimulate hair that is in the recovery phase
  • Camouflage techniques:  wigs, color sticks or crayons, micropigmentation
  • Surgery: for stable disease, hair