What is Central Centrifugal Cicatricial Alopecia (CCCA)?

Central Centrifugal Cicatricial Alopecia (CCCA) is a condition that causes permanent hair loss, primarily in the crown area. This type of hair loss is most common among Black women aged 30 to 55 but can also affect men and people of all races, though rarely. CCCA hair loss often starts with inflammation and leads to scarring on the scalp. Over time, this scarring makes it impossible for hair to grow back. While the exact cause is not fully understood, contributing factors may include certain hairstyling practices, such as tight braids or chemical relaxers. By recognizing the symptoms early, individuals can explore treatments to prevent further hair loss and protect their scalp health.

Causes of Central Centrifugal Cicatricial Alopecia (CCCA)

The exact cause of central centrifugal cicatricial alopecia (CCCA) remains unclear, and experts believe it is likely influenced by multiple factors. While no single cause has been proven, several theories and findings provide insight into what may contribute to this condition.

Genetic Factors

The exact cause of CCCA isn’t fully understood, but it likely involves multiple factors. One possible cause is genetics. Researchers have found a link to changes in a gene called PADI3, which encodes a protein that plays a vital role in the formation of the hair shaft. However, the precise role of this genetic mutation in the development of CCCA is still under investigation. Additionally, researchers have found that women with CCCA are more likely to have uterine fibroids.

Hairstyling Practices

Historically, certain hairstyling methods have been suspected to contribute to CCCA hair loss. Practices such as using hot combs, chemical relaxers, tight braids, extensions, and weaves have been implicated. These techniques may exert excessive pressure on the hair follicles, potentially causing inflammation and scarring over time. However, studies have not established a consistent or definitive link between these practices and CCCA. Many individuals with CCCA have no history of traction-based hairstyles, challenging this theory.

Infections and Autoimmune Diseases

Bacterial and fungal infections have been proposed as possible contributors to the development of CCCA. These infections may trigger inflammation in the hair follicles, which could lead to scarring and permanent hair loss. Additionally, some researchers suggest that autoimmune diseases, in which the body’s immune system attacks healthy cells, may play a role in the condition. However, these connections remain unproven and require further study.

A Complex Puzzle

Overall, CCCA appears to result from a combination of genetic, environmental, and medical factors. Despite ongoing research, much remains unknown about how these elements interact to cause the condition. Further studies are needed to unravel the mechanisms behind CCCA and to explore effective prevention and treatment strategies.

Symptoms of Central Centrifugal Cicatricial Alopecia (CCCA)

Central centrifugal cicatricial alopecia (CCCA) is a progressive condition, meaning symptoms often worsen over time. It primarily affects the scalp and can cause noticeable discomfort and permanent hair loss if left untreated. Below are the common clinical features and symptoms of CCCA:

Hair Loss Pattern

Hair loss typically begins at the vertex or crown of the scalp and spreads outward in a circular (centrifugal) pattern. This progressive loss often makes the affected area appear smooth and shiny due to the destruction of hair follicles. Over time, the absence of follicular openings becomes more pronounced, indicating permanent hair loss.

Scalp Symptoms

Some individuals may experience no symptoms beyond hair loss, but others report significant discomfort, including:

• Tenderness: A sensitive or sore scalp, especially in the affected areas.
• Itching: Persistent irritation that may worsen with scratching.
• Burning: A sensation of heat or inflammation in the scalp.

These symptoms are often caused by inflammation in the underlying tissues.

Early Signs

Before noticeable hair loss occurs, hair breakage may be an early indicator of CCCA. This can happen as the hair becomes weaker near the roots, leading to uneven lengths or thinning patches.

Progression and Severity

Hair loss in CCCA is slow and gradual, making it easy to overlook in its early stages. Over time, as more follicles are destroyed, the condition can become more severe.

Diagnosis of Central Centrifugal Cicatricial Alopecia (CCCA)

Diagnosing central centrifugal cicatricial alopecia (CCCA) typically involves a thorough clinical examination of the scalp by a healthcare professional. The process may include several steps to confirm the condition and rule out other potential causes of hair loss.

Clinical Examination

During the initial examination, the physician carefully inspects the scalp to assess the pattern of hair loss, identify signs of scarring, and check for inflammation. Hair loss in CCCA often begins at the crown and spreads outward in a circular pattern, which helps distinguish it from other forms of alopecia.

Dermatoscopy

A dermatoscope, a handheld magnifying tool with a built-in light, is often used to examine the scalp more closely. This device allows the physician to identify subtle changes, such as the absence of follicular openings, which is a hallmark of CCCA. It also helps detect signs of active inflammation or damage to hair follicles.

Scalp Biopsy

In some cases, a scalp biopsy may be performed to confirm the diagnosis. This procedure involves removing a small sample of the scalp skin, which is then examined under a microscope. The biopsy can reveal key features of CCCA, such as scarring, inflammation, or destruction of hair follicles, providing valuable insight into the condition’s severity and progression.

Why Early Diagnosis Matters

Early diagnosis of CCCA is crucial to prevent further hair loss and manage symptoms effectively. If you notice hair thinning at the crown, scalp tenderness, or other signs of CCCA, consult a healthcare professional promptly for a proper evaluation and diagnosis.

Treatment Options for Central Centrifugal Cicatricial Alopecia (CCCA)

The primary goal of treating central centrifugal cicatricial alopecia (CCCA) is to stop or slow hair loss, manage symptoms, and prevent further damage. While regrowth is not possible in areas where the hair follicles have been replaced by scarring, treatments can help preserve remaining hair and improve scalp health.

Medications to Reduce Inflammation

Inflammation plays a significant role in CCCA, and many treatments aim to address this issue.

Corticosteroids: These are commonly prescribed to reduce inflammation quickly.

• Topical corticosteroids are applied to the scalp daily for two to four weeks and then tapered.
• Corticosteroid injections may be administered monthly for six to eight months to target inflammation in specific areas.

Calcineurin Inhibitors: Medications like tacrolimus ointment and pimecrolimus cream may be used to reduce inflammation.

Some medications are used for more severe cases to suppress the immune response and manage inflammation.

Hair Care Practices

Adjusting hair care routines is a critical part of managing CCCA. Dermatologists recommend the following:

• Discontinue Traumatic Practices: Avoid tight braids, weaves, or hairstyles that cause discomfort or scalp irritation.
• Minimize Heat: Reduce the use of hot combs, flat irons, and blow dryers.
• Relaxer Use: If relaxers are used, they should be applied by a professional, no more than every 6–8 weeks, ensuring no scalp burns occur.
• Shampooing Frequency: Shampooing every 1–2 weeks is recommended to maintain scalp moisture and prevent dryness.

Promoting Hair Regrowth

Minoxidil Solution: This topical medication can help stimulate growth in viable hair follicles and is often included in treatment plans.

Advanced Options

Hair Transplantation: This option may be considered for patients with well-controlled and stable CCCA for at least one year. However, graft survival rates are generally low.

Conclusion

In conclusion, central centrifugal cicatricial alopecia (CCCA) is a complex condition requiring early diagnosis and tailored treatments to manage symptoms and prevent further hair loss. By addressing inflammation, adopting healthy hair care practices, and consulting dermatologists for personalized plans, individuals can protect their scalp health and maintain their remaining hair effectively.