Chapter 10 - Central Centrifugal Cicatricial Alopecia

Abstract

Central centrifugal cicatricial alopecia (CCCA) is a common lymphocytic scarring alopecia seen predominantly in middle-aged women of African descent. It may occur in families, and an autosomal dominant inheritance pattern with partial penetrance has been described. A large void in our knowledge exists regarding various aspects of disease etiology, pathogenesis, and management, because of limited data on the subject. CCCA presents as a chronic, progressive hair loss of the central scalp that extends centrifugally and symmetrically. Although it is usually asymptomatic, it does significantly have impact on patients' quality of life. Management is aimed at halting disease progression at an early stage, and multiple topical and systemic treatments have proved effective in gaining disease control in most cases. Unfortunately, patients present late in the course of disease when significant scarring and permanent hair loss has already occurred. Surgical options to restore hair loss present a beacon of hope in some clinically indicated cases. Because of the paucity of available data on the subject, newer research is warranted to better understand disease characteristics and formulate in-depth treatment guidelines. Teaching of hairstylists in hair salons to detect early features of the disease may prove useful in the long term.