central Cicatricial Centrifugal Alopecia
Central Cicatricial Alopecia in Black Women
HEALTHY HAIR TIPS FOR CCCA
Do NOT oil/grease your scalp
Shampoo every week (preferred) or no less than every other week
Minimize heat from hooded dryers and blow dryers
Avoid hair products with castor oil, shea butter, mineral oil and petroleum
HEALTHY HAIR STYLES FOR PATIENTS WITH CCCA
Hairstyles that allow for full access to your scalp and avoid tension on the scalp.
Curly Cuts
Wash & Go
Wigs (removable & unanchored)
Overview:
Central Centrifugal Cicatricial Alopecia (CCCA) is a form of scarring hair loss (alopecia) most common in African American women. There is a genetic basis for CCCA meaning it can run in families, however, hair care and styling practices are also linked to the condition. Patients experience progressive hair loss at the vertex of the scalp. Medication and hair care changes can slow progression, however, areas that have scarred do not generally regrow.
Causes
The exact cause of CCCA is unknown, but it's thought to be a combination of genetic and environmental factors. Family history is a risk factor, as ccca can run in families. A recent study published in the New England Journal of Medicine showed PADI3 mutations are linked to development of CCCA. This has also been identified in fibroids. In addition, hairstyling practices that pull on the hair (such as tight braids or cornrows) are thought to play a role. CCCA is seen most often in African American women, which suggests that genetics may play a role. Although the exact number is unknown, it is estimated that CCCA may affect up to 15% of black women in the general population.
Signs and Symptoms
Early signs include hair breakage at the top of the scalp, scalp burning, itching and tingling. Some may feel small, raised bumps on their scalp or areas of swelling/bogginess. The main symptom of CCCA is progressive hair loss at the vertex (top) of the scalp. The hair loss may start as thinning, but can progress to balding.
Diagnosis
Diagnosis may be made clinically and with a scalp biopsy.
Prognosis/expectations
You may be able to reverse (or grow some hair) if you treat CCCA early before hair follicles develop scars. Once a hair follicle scars completely, treatment to regrow hair becomes difficult and hair loss is more likely to be permanent.
While treatment for CCCA may not always be able to reverse the disease and regrow hair, treatment can prevent CCCA from destroying more hair follicles. This means that the patch of hair loss that you have can remain the same size instead of getting larger. Without treatment, CCCA often continues to destroy hair follicles, and the patch of hair loss becomes larger and may eventually involve most of the scalp.
Management
There is no cure for CCCA, but treatments can help slow the progression of hair loss.
Hairstyle modification: Gentle hair grooming practices such as natural (chemical and heat-free) hair styles, reduced frequency of relaxers, and limited styling products, are also recommended in order to prevent inflammation and concomitant hair breakage.
Vitamin Supplementation: Vitamin D and Iron
Nutrafol: The #1 dermatologist-recommended hair growth supplements for men and women.
Minoxidil: Available as a prescription pill or as over-the-counter medication (Rogaine) applied to the scalp to promote hair growth. It must be used indefinitely to maintain results.
Anti-seborrheic shampoo (ciclopirox, ketoconazole, pyrithione zinc)
Oral Antibiotics (doxycycline, minocycline): Used for their anti-inflammatory properties to stabilize disease and often gradually discontinued after improvement.
Steroid injections (intralesional triamcinolone): These are injected into the scalp to help reduce inflammation and promote hair growth.
Topical steroids: Anti-inflammatory topical medications applied to the scalp to reduce inflammation and help promote hair growth.
Topical nonsteroid anti-inflammatory medications (tacrolimus): Anti-inflammatory effect
Topical diabetes medication (metformin): A topical compound of the common diabetes medication metformin has been found to reduce disease activity and improve hair in patients with CCCA. *Available by compounding pharmacy only
Non steroid immunosuppressives (mycophenolate mofetil, hydroxychloroquine, cyclosporine): These are taken by mouth as steroid sparing long term options to limit progression. Such agents may increase risk of infection.
Platelet rich fibrin (PRF): With a simple blood draw, PRF employs your body’s own cell growth factors to regenerate and restore the inactive hair follicle through wound-healing technology. These specific growth factors are essential in tissue regeneration and healing.
Hair transplantation: hair transplantation can be performed in CCCA, however, hair loss must be stable / quiescent for at least 1 year prior to proceeding. If your hair transplant surgeon is not also a dermatologist, you should be sure you are seeing a dermatologist as well to monitor the activity level of your CCCA. Any hairs transplanted into active CCCA will likely be lost with time.