What is Central Centrifugal Cicatricial Alopecia (Hair Loss)?
Central centrifugal cicatricial alopecia (CCCA) is a special type of hair loss that leaves scars. It usually appears as patches of permanent hair loss on the top or crown of the head and spreads outward. This kind of hair loss often comes with signs of inflammation. CCCA commonly affects women of African heritage and can run in families. There’s not much information about how to treat CCCA. Some treatments include creams and pills that contain corticosteroids, as well as oral tetracycline, but these methods don’t always work. The effects and duration of the condition can vary widely from person to person.
What Causes Central Centrifugal Cicatricial Alopecia (Hair Loss)?
The exact cause of a hair loss condition called CCCA isn’t fully known, and several theories exist. Some people thought that hair care products often used by Black women – like relaxers and hot combs – could play a part, but this idea was dismissed when it was noticed that women who didn’t use these products also had CCCA.
Other thoughts about what might cause CCCA revolve around early shedding of a part of the hair shaft, which might let external elements like chemicals or bacteria get inside the hair, leading to inflammation. There is some support for this in the form of physical evidence of early shedding observed in CCCA tissue samples.
Another theory is that CCCA could be linked to a disorder that causes inflammation and scarring of the hair follicle, which then disrupts hair growth. However, currently, there is no solid proof to back up any of these theories.
To sum up, it’s likely that CCCA is caused by a combination of factors. Other possibilities that have been suggested include infections, autoimmune diseases, or genetic factors. There’s also a chance that CCCA could occur for no apparent reason, but more research is needed to understand this better.
Risk Factors and Frequency for Central Centrifugal Cicatricial Alopecia (Hair Loss)
Central centrifugal cicatricial alopecia (CCCA) is a common type of hair loss condition found in middle-aged women of African descent with tightly curled or kinky hair. Studies indicate that between 2% and 7% of these women experience this issue. CCCA is not common in men and children, but there have been some reported cases. On average, women start experiencing this condition from the age of 36.
These are the current known details about CCCA, based on smaller city-based studies. While it is important to have more extensive studies conducted for more accurate information, there is currently no well-documented evidence on the impact of CCCA on other population groups.
Signs and Symptoms of Central Centrifugal Cicatricial Alopecia (Hair Loss)
Central centrifugal cicatricial alopecia (CCCA) is a condition that affects the scalp, causing hair loss. Its diagnosis can be made through a medical examination and understanding your medical history. There are certain signs and observations that doctors look for:
- The condition typically starts at the top of the scalp
- The hair loss usually moves outward in a symmetrical pattern
- The scalp feels soft when touched
- There might be mild darkening (hyperpigmentation) around the hair follicles
- The area with hair loss blends slowly with the rest of the scalp
- In a specialized skin examination (dermoscopy), there could be loss of follicular openings or a white ring around the hair root (peripilar halo)
- There could be mild burning, tenderness, or itching in the area of hair loss
- Patches of unaffected hair within the area of hair loss may be observed
- Historical factors could include chemical use, African descent, tight hairstyles, and hot comb use
Testing for Central Centrifugal Cicatricial Alopecia (Hair Loss)
If a woman of Afro-Caribbean heritage is losing hair from the top of her head, there’s a possibility that she might be suffering from a condition called Central Centrifugal Cicatricial Alopecia (CCCA). To diagnose CCCA, your doctor might use a special tool for inspecting the hair and scalp (a trichoscope) that could reveal specific signs, such as white circles around the hair root, loss of hair follicles, an irregular distribution of tiny white dots, and broken hair strands.
Besides looking at your hair under a trichoscope, the doctor might also observe the quality of your hair, checking for things like length, thickness, and whether the ends are broken. If your hair has blunt tips or “broomstick ends”, this could be a sign of damage or a condition called trichorrhexis nodosa. If the ends of your hair are split, it might indicate damage due to heat or harsh chemicals.
To rule out another hair loss condition called telogen effluvium, your doctor might perform a hair pull test. Telogen effluvium occurs when more hairs than normal enter the shedding phase. If your doctor pulls on several strands of your hair and more than a few come out, it may be telogen effluvium.
The doctor would also look out for other symptoms such as acne, excessive hair growth, obesity, and irregular periods as they might indicate female pattern hair loss due to hormonal imbalance. They also might recommend blood tests to check for things like hormone levels and nutrient deficiencies, which can all impact hair health.
The doctor might test for anemia, liver and kidney diseases, thyroid problems, syphilis, and autoimmune diseases, which can sometimes cause hair loss. A scalp infection caused by fungus (tinea capitis) can be ruled out after analyzing a sample from your scalp under a microscope.
In the end, a definitive diagnosis is typically confirmed through small skin biopsies from the edge of the balding area. Some sources note that a single biopsy may be enough for a conclusive diagnosis.
Treatment Options for Central Centrifugal Cicatricial Alopecia (Hair Loss)
The goal of treatment for CCCA, a condition causing hair loss, is to encourage the hair to grow back and stop the disease from progressing. However, it’s important to remember that if hair follicles are permanently damaged, hair won’t regrow from those areas. There aren’t specific guidelines for treating this condition and most treatment methods are based on practical experience rather than solid evidence. Starting treatment early, however, can help to slow down the progression of the disease.
The response to treatment for CCCA is usually slow. The first treatment usually tried is anti-inflammatory medication, which can be applied directly to the skin or given via injection. Topical steroids can be helpful, and using a lower concentration can reduce the risk of skin discoloration in people with darker skin. Antibiotics like doxycycline also work well and should be continued until improvement is seen, which can take 2 to 6 months. After the condition has been stable for at least a year, the dose may be lowered and then gradually stopped.
In some cases, other anti-inflammatory treatments like mycophenolate mofetil, hydroxychloroquine, and cyclosporine have been used. In cases where there is active inflammation, short courses of oral corticosteroids could be beneficial. Vitamin D may also play a role in treatment. Though not proven, reducing and modifying hair care practices, like avoiding aggressively pulling the hair, could help. Washing with a mild shampoo weekly can provide some relief.
There have also been small studies on the use of minoxidil, topical metformin, and tacrolimus for treatment. However, these are not widely accepted methods at this time.
What else can Central Centrifugal Cicatricial Alopecia (Hair Loss) be?
Central centrifugal cicatricial alopecia (CCCA) is a condition that involves hair loss and can often be mistaken for:
– Female pattern hair loss: This type of hair loss typically happens after menopause or during puberty and it’s related to an excess of male hormones. However, unlike CCCA, there is no scarring, and the hair follicles are still visible.
– Lichen planopilaris: Another cause of scarred hair loss, which can sometimes look quite similar to CCCA. Differences include redness around the hair follicles and hard skin bumps. There is another form of this condition called frontal fibrosing alopecia, that also causes facial bumps and typically results in scarred hair loss on the scalp as well as loss of eyelashes, eyebrows, and hair on other parts of the body.
– Tinea capitis: A scalp infection caused by a fungus that can cause both scarred and non-scarred hair loss. This condition can be identified by a unique glow under a special lamp, bright green for microsporum fungus and a faint blue for Trichophyton schoenleinii fungus.
– Discoid lupus erythematosus: Another pattern of scarred hair loss that usually happens on the scalp, distinguished by red scaly patches and changes in skin color. This condition separates itself from CCCA through skin biopsies because it shows a notably different reaction in the skin’s immune response and breakdown of the skin’s primary layer.
– Pseudopelade of Brocq: Usually affecting middle-aged and older women, it causes irregularly shaped patches of hair loss that often start at the top of the head. The bald spots have been described as looking like ‘footprints in the snow.’ The microscopic study of the skin shows a thin outermost skin layer with hardening in the lower layers, extending to the fatty layer below.
Differentiating Lichen planopilaris and CCCA can be particularly challenging due to superficial similarities. Both conditions present with damage and inflammation around the hair follicle leading to loose hair shafts in the skin layer. However, observations of skin cells under the microscope demonstrate differences, such as the presence of particular skin changes and inflammation around the hair follicle in Lichen planopilaris, among others. Similarly, frontal fibrosing alopecia also shows steady hair follicle loss along with a specific pattern of skin cell changes.
What to expect with Central Centrifugal Cicatricial Alopecia (Hair Loss)
The outcome for central centrifugal cicatricial alopecia (CCCA), better known as a type of permanent hair loss, differs based on how early it’s caught. If diagnosed early and treated properly, there’s a good chance hair might regrow. However, if the condition is discovered at a late stage, the prospects aren’t as good, mostly due to delays in diagnosis and treatment.
By the time advanced cases are identified and treated, the disease may have already caused scarring, which only allows for minuscule hair regrowth. This is why early detection and intervention are so vital in managing this condition.
Possible Complications When Diagnosed with Central Centrifugal Cicatricial Alopecia (Hair Loss)
The main issues that arise with CCCA, a type of hair loss that leaves scarring, are usually due to it being diagnosed too late or misdiagnosed. Once the hair is damaged, it can be hard to restore. The symptoms can vary greatly, from no symptoms at all, all the way to severe discomfort. These symptoms can include burning, itching, and tenderness. The goal of treatment is to protect any hair that is yet to be affected and stop the disease from getting worse. Patients should be made fully aware of the seriousness of the condition and all available treatment options.
Common Problems and Symptoms:
- Late diagnosis
- Misdiagnosis
- No symptoms
- Burning
- Itching
- Tenderness
Preventing Central Centrifugal Cicatricial Alopecia (Hair Loss)
It’s crucial to educate patients about central centrifugal cicatricial alopecia, a condition that can cause a lot of worry. The more patients know about their condition, the better they can manage it. It’s important to understand that while there’s no cure in the scarring stage, the condition can be controlled and managed properly.
Patients should stay clear of hair practices that involve heat or cause any kind of friction. Using hair relaxers often could potentially worsen the condition, so it’s best to avoid such products. Furthermore, patients – along with their healthcare providers – are encouraged to join support groups and organizations that advocate for healthy hair practices. This helps in managing their condition better and reduces feelings of isolation and anxiety.
