What is Central Centrifugal Cicatricial Alopecia (CCCA)?

Central Centrifugal Cicatricial Alopecia (CCCA) is a type of hair loss that primarily affects African American women, but it can affect men and women of varying ethnicities.  To date there are not many population based studies available.  It involves the destruction of hair follicles, leading to scarring and permanent hair loss. The condition typically starts at the crown or centre of the scalp and spreads outward, forming a circular pattern.

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What Causes CCCA?

The exact cause of CCCA is not fully understood, but several factors may contribute to its development:

• Genetics: Family history can play a significant role in CCCA, indicating a possible genetic predisposition.

• Hair Care Practices: Frequent use of chemical relaxers, hot combs, and tight hairstyles (like braids and weaves) may contribute to follicle damage.

• Inflammation: Chronic inflammation around hair follicles might lead to their destruction and subsequent scarring.

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What are the Symptoms of CCCA?

• Gradual hair loss starting at the crown and expanding outward

• Scalp tenderness or pain

• Itching and burning sensations on the scalp

• Small bumps or pustules in the affected area

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How Does CCCA Progress?

CCCA progresses slowly over time. Initially, hair loss may be subtle and localized to the crown. As the condition advances, hair loss spreads outward, creating a more noticeable bald spot. Without treatment, the condition can lead to extensive hair loss and permanent scarring.

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How is CCCA Diagnosed?

Diagnosis involves a combination of medical history, physical examination, and diagnostic tests:

• Medical History and Physical Exam: Your doctor will review your symptoms, family history, and hair care practices.

• Scalp Biopsy: A small sample of scalp tissue may be taken to examine the hair follicles and confirm the diagnosis.

• Dermatoscopy: This non-invasive technique uses a special magnifying tool to inspect the scalp closely.

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What are the Treatment Options for CCCA?

Treatment aims to halt the progression of hair loss and manage symptoms.  Be advised that, depending on the progression of hair loss, especially if scarring has already occurred, there are no treatment options available at this time that can regrow the hair.  

• Topical Corticosteroids: These anti-inflammatory creams may reduce inflammation and slow hair loss.

• Oral Medications: Antibiotics or immunosuppressive medications may be prescribed to address inflammation or infection.

• Minoxidil: This topical solution may promote hair growth in some cases.

• Intralesional Steroid Injections: Direct injections into the scalp may help reduce inflammation and stimulate hair growth.

• There are no vitamins, supplements, essential/carrier oils or dietary changes that can reverse or have been proven to regrow hair once scarring is prevalent.

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Coping with CCCA 

Living with hair loss can be challenging, but several strategies can help you cope:

• Seek Support: Join support groups or online communities to connect with others who have CCCA.

• Educate Yourself: Learn as much as you can about your condition to make informed decisions about your treatment.

• Explore Styling Options: Wigs, scarves, and creative hairstyles can help you feel more confident and comfortable.  Accessories such as jewelry and henna crowns can also help in the creative process. 

• Consider Counseling: A therapist can provide emotional support and coping strategies to manage the psychological impact of hair loss.

• Maintain a Healthy Scalp: Gentle hair care practices, a balanced diet, and avoiding harsh chemicals can promote overall scalp health.

 

Conclusion

Central Centrifugal Cicatricial Alopecia is a complex condition that requires a multifaceted approach to management. Understanding the causes, recognizing symptoms, and seeking appropriate treatment can help slow the progression of hair loss and improve quality of life. If you suspect you have CCCA, consult a dermatologist to develop a personalized treatment plan and explore ways to cope with hair loss effectively.

References: 

Whiting, D. A., & Olsen, E. A. (2008). Central centrifugal cicatricial alopecia. Dermatologic therapy, 21(4), 268-278.

 

Gathers, R. C., & Lim, H. W. (2009). Central centrifugal cicatricial alopecia: past, present, and future. Journal of the American Academy of Dermatology, 60(4), 660-668.

 

Raechele Cochran Gathers, Henry W. Lim,

Central centrifugal cicatricial alopecia: Past, present, and future,

Journal of the American Academy of Dermatology,

Volume 60, Issue 4,

2009,

Pages 660-668,

ISSN 0190-9622,

https://doi.org/10.1016/j.jaad.2008.09.066.

(https://www.sciencedirect.com/science/article/pii/S0190962208014448)

 

Herskovitz, I., & Miteva, M. (2016). Central centrifugal cicatricial alopecia: challenges and solutions. Clinical, Cosmetic and Investigational Dermatology, 9, 175–181. https://doi.org/10.2147/CCID.S100816

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Disclaimer: The information provided in the Alopecia Frequently Asked Questions (FAQs) section is intended for general informational purposes only and should not be construed as medical advice. While we strive to offer accurate and up-to-date content, the FAQs are not a substitute for professional diagnosis, treatment, or advice from qualified healthcare providers. Individual experiences with alopecia may vary, and it is important to consult with a healthcare professional for personalized medical guidance. We do not endorse any specific treatments, products, or services mentioned in the FAQs. Reliance on any information provided in this section is solely at your own risk.