Central Centrifugal Cicatricial Alopecia (CCCA)

Overview / Definition Central Centrifugal Cicatricial Alopecia (CCCA) is a type of scarring alopecia that primarily affects individuals with skin of color, particularly women of African descent. It is characterized by hair loss that begins at the crown of the scalp and radiates outward, resulting in cicatricial (scarring) changes in the scalp. This condition leads to the destruction of hair follicles and is associated with significant psychological impact. Epidemiology CCCA is considered one of the most common forms of hair loss among women of African descent. Although exact prevalence rates are not well documented, studies suggest that it may affect up to 30% of African American women at some point in their lives. The condition is often seen in individuals aged between 20 and 50 years. Pathophysiology / Mechanism The precise etiology of CCCA is not fully understood, but it is believed to be multifactorial, involving both genetic and environmental factors. The condition is associated with: Traction alopecia: Frequent hairstyles that exert tension on the hair follicles. Inflammation: The presence of inflammatory cells in the scalp, leading to follicular damage. Genetic predisposition: Family history may play a role in susceptibility. Clinical Presentation Patients with CCCA typically present with: Alopecia that begins at the crown and spreads centrifugally. Scalp tenderness or itching in the affected areas. Visible scarring on the scalp, often with a smooth, shiny appearance. Poor hair growth or absence of hair follicles in the affected areas. It is important to differentiate CCCA from other forms of alopecia, as the presence of scarring is a key feature. Diagnosis / Workup The diagnosis of CCCA is primarily clinical but may include: A thorough history and physical examination. Trichoscopy, which may reveal key features such as perifollicular erythema and white dots. Scalp biopsy may be necessary to confirm the diagnosis and assess the degree of inflammation and scar