Own Central Centrifugal Cicatricial Alopecia (CCCA)

Central Centrifugal Cicatricial Alopecia (CCCA)—a term that may seem like a mouthful—is a form of scarring hair loss that primarily affects women of African descent but can also impact men, who are sometimes misdiagnosed with other types of hair loss. Let’s break down what CCCA is, how it differs from other hair loss conditions, and what you can do if you or someone you know is affected.

 

What Is CCCA?

CCCA is a type of hair loss that starts at the vertex or central part of the scalp and gradually spreads outward. The term "centrifugal" refers to this outward spread, while "cicatricial" signifies that it involves scarring. This scarring hair loss can lead to permanent and irreversible changes to the scalp, resulting in lasting hair loss in the affected areas.

 

Who Is Affected?

CCCA can begin in individuals as young as their late 20s and can continue into their 50s and 60s. Often, people don’t seek medical advice until the condition becomes more noticeable, sometimes due to a lack of awareness or misconceptions about hair loss as a normal part of aging.

Many patients delay visiting a dermatologist because they may believe their hair loss is a natural part of aging or because their hair grooming practices are masking the gradual hair loss. Common hair grooming practices, such as braiding, weaves, and perming, can sometimes cover up the early signs of CCCA.

 

Symptoms and Causes

Symptoms of CCCA vary. Some people experience no symptoms at all, discovering their hair loss only when it becomes noticeable. Others may have itching, burning, or a feeling of tightness in the affected areas. The exact cause of CCCA is not well understood, but it appears to have a genetic component, with some mutations making individuals more prone to the condition.

Hair grooming practices involving constant tension, chemical treatments like relaxers, or physical irritation could contribute to the development of CCCA. While these practices might not directly cause CCCA, they can exacerbate existing irritation and inflammation, potentially accelerating hair loss.

 

Managing Hair Grooming Practices

If you notice signs of scalp irritation—such as itching, burning, or changes in scalp color—it's crucial to modify or eliminate practices that may be aggravating the condition. For example:

- Braids and Extensions: Opt for looser braids or extensions to reduce tension on the scalp.

- Chemical Treatments: Use gentle, no-lye relaxers and minimize the frequency of chemical treatments.

- Overall Care: Avoid practices that cause immediate irritation or discomfort.

 

If symptoms persist despite modifying these practices, consulting a dermatologist is essential. Hair care professionals, including stylists and barbers, can also help by identifying unusual scalp conditions and recommending when to seek further evaluation.

 

Treatment Options

Treating CCCA can be challenging, but there are several options available:

1. Topical and Injected Steroids: These can help reduce inflammation and slow the progression of hair loss. Recently, a there have been a few promising reports regarding the efficacy of topical metformin for patients suffering from CCCA.

2. Minoxidil: While not always effective, it can sometimes help stimulate hair growth.

3. Hair Transplantation: This procedure involves transferring hair follicles from unaffected areas to the balding regions, potentially improving appearance.

4. Platelet-Rich Plasma (PRP): This newer technique involves using a concentration of platelets from the patient’s own blood to promote hair growth. While research is ongoing, some case reports and clinical experiences suggest promising results.

 

Recently, there have been a few reports of topical metformin achieving regrowth in a patients with CCCA.

 

Staying updated with the latest research and treatment options is crucial, as new methods and clinical trials are continually evolving.

 

Conclusion

CCCA is a complex condition with significant impacts on those affected. Understanding its symptoms, potential causes, and treatment options can help manage and potentially alleviate some of the challenges associated with this type of hair loss. If you suspect you have CCCA or are struggling with hair loss, seek guidance from a dermatologist to get a proper diagnosis and explore appropriate treatment options.

Thanks for reading and God bless.

 

Yuval Bibi, MD/PhD - Board Certified Dermatologist