Central centrifugal scarring alopecia L66.8

Lopresti P et al. 1968.

The original theory was that African-American styling techniques such as relaxers, tight braids, heavy extensions, certain oils, gels or pomades damage the follicles and lead to irreversible hair loss. It was later discovered that CCCA also affects men and women who have no significant history of using such styling techniques. Consequently, the terms "follicular degeneration syndrome" (Sperling et al. 1992) and later CCCA (central centrifugal cicatricial alopecia/Olsent et al. 2003) were proposed. More recent research on CCCA supports the concept that variants in gene expression (e.g. mutations in PADI3) and associations with other systemic diseases also occur.

Central centrifugal scarring alopecia is an aetiologically unexplained inflammatory follicular atrophying disease of the capillitium which occurs predominantly in women of African descent. The disease was previously also known as hot comb alopecia (LoPresti P et al. 1968) or as "follicular degeneration syndrome" (see Blattner C et al. 2013).

Central centrifugal cicatricial alopecia (CCCA) is the most common form of primary cicatricial alopecia diagnosed in women of African descent, with a prevalence of 2.7 to 5.6 %. (Lawson CN et al. 2021).

The exact etiology of CCCA is unknown, presumably multifactorial. It is believed that a causative factor is hair styling techniques that predispose abnormal follicles to injury. Such practices include tight braiding with excessive tension, heavy hair extensions, chemical straighteners, colorants, heat and styling products.

Possible other causes include an autosomal dominant inheritance pattern and the intrinsically curly nature of black hair, which is more susceptible due to its texture. Although the epidemiology and prevalence are not yet clearly defined due to a lack of well-designed, population-based studies, current literature suggests that the condition primarily affects adult women of African descent.

The average age of onset is 36 years. The first sign is often unexplained hair breakage, followed by thinning of the hair, which mainly affects the crown region.

Scarring alopecia in the vertex area of the capillitium as a result of chronic inflammation of unknown etiology. In the course of the disease, a slow, often symmetrical peripheral spread becomes apparent. Perifollicular erythema and hyperpigmentation, polytrichia (fused infundibula) and islets of unaffected skin are found (Kanti V et al. 2018).

Perifollicular lymphocytic infiltrate, signs of follicular degeneration and fibrosis.

Topical or intralesional glucocorticoids.

Systemic: Doxycycline, oral glucocorticoids, hydroxychloroquine, ciclosporin.

1. Blattner C et al (2013) Central centrifugal cicatricial alopecia. Indian Dermatol Online J 4:50-51.
2. Ezekwe N et al. (2020) The Use of Natural Ingredients in the Treatment of Alopecias with an Emphasis on Central Centrifugal Cicatricial Alopecia: A Systematic Review. J Clin Aesthet Dermatol 13:23-27.
3. Gathers RC et al. (2009) Central centrifugal cicatricial alopecia: past, present, and future. J Am Acad Dermatol 60:660-668.
4. Kanti V et al (2018) Scarring alopecia. JDDg 16: 435-4611
5. Khumalo NP et al. (2007) Hairdressing and the prevalence of scalp disease in African adults. Br J Dermatol 157:981-988.
6. Lawson CN et al (2021) Central Centrifugal Cicatricial Alopecia: Challenges and Treatments. Dermatol Clin 39:389-405.
7. LoPresti P et al (1968) Hot comb alopecia. Arch Dermatol 98:234-238.
8. Ogunleye TA et al. (2014) Central centrifugal cicatricial alopecia: what has been achieved, current clues for future research. Dermatol Clin 32:173-181.
9. Olsen EA et al. (2011) Central hair loss in African American women: incidence and potential risk factors. J Am Acad Dermatol 64:245-252.