Central centrifugal cicatricial alopecia is a less talked about but very challenging form of hair loss. It mainly affects younger women of black heritage. Unlike more common types of hair loss like androgenetic alopecia, central centrifugal cicatricial alopecia actually causes permanent damage to hair follicles. This then leads to irreversible hair loss and so early diagnosis and treatment are vital. In this article, we’ll explore the causes of central centrifugal cicatricial alopecia, diagnosis and best treatment options.
What is Central Centrifugal Cicatricial Alopecia?
Central centrifugal cicatricial alopecia (CCCA) is an inflammatory scalp condition and a type of scarring alopecia. It gradually leads to the destruction and scarring of hair follicles. This then results in permanent hair loss. CCCA usually affects the crown or vertex of the scalp. It initially appears as subtle hair thinning on the crown which then progressively expands outwards over time and the baldness becomes more apparent. In fact, the name itself (central centrifugal cicatricial alopecia) accurately describes how this disease progresses:
- Central: Begins at the centre of the scalp.
- Centrifugal: Expands outward gradually.
- Cicatricial: Causes scarring thus permanently damaging hair follicles.
- Alopecia: Results in hair loss.
CCCA mainly affects younger people (aged between 30-55) and in particular women of African descent. In fact as much as 15% of black women may suffer from this condition. Of course, it can also occur in men and people across different age groups as well as various ethnic backgrounds. It is likely that the number of true people suffering from CCCA is higher than we know. This is because there’s often misdiagnosis at the early stages as the symptoms can resemble other more common forms of hair loss.
Causes of Central Centrifugal Cicatricial Alopecia
We don’t full know the exact cause of CCCA which obviously makes diagnosis and treatment even more difficult. However, researchers have identified several factors that seem to significantly contribute to its development and progression. The primary contributing factors and triggers for central centrifugal cicatricial alopecia include:
- Genetics: If your immediate family members have CCCA it significantly increases the likelihood of you developing it. As such, it seems that there is a strong genetic component and certain gene abnormalities may play a role.
- Hairstyling Practices: Certain styling practices may trigger or worsen CCCA. In particular, tight hair styles such as braids, weaves, corn rows or pony tails place continuous tension on hair follicles which causes inflammation. This can eventually lead to permanent scarring. Additionally, chemical treatments like relaxers, perms or frequent colouring can weaken hair structure and further inflame the scalp hence worsening symptoms.
- Autoimmune Factors: The body’s immune system can sometimes mistakenly target your own healthy cells. In CCCA, immune cells may attack the hair follicles and cause chronic inflammation. This prolonged inflammation can then lead to irreversible scarring and hair follicle destruction.
Symptoms & Diagnosis
Recognising central centrifugal cicatricial alopecia early is crucial. This is because prompt identification can greatly minimise the severity of hair loss and significantly improve treatment outcomes. However, symptoms can start subtly and often initially go unnoticed. Below are the moat common signs to look out for:
- Thinning hair at the crown or top of the scalp that slowly expands outward.
- Persistent scalp itching, sensitivity or tenderness.
- Visible scalp inflammation which is often accompanied by redness.
- Advanced signs such as shiny, smooth patches on the scalp. These can indicate permanent scarring.
If you notice one or more of these symptoms, seek medical help without delay. Accurate diagnosis is the next step and usually needs a thorough history and examination by a dermatologist or other hair specialist. Diagnosis generally includes:
- A thorough clinical examination to assess visible symptoms.
- Your doctor may perform a scalp biopsy to confirm inflammation and scarring.
- Blood tests can help to eliminate other potential underlying medical conditions or autoimmune diseases that can cause similar types of hair loss.
Treatments for Central Centrifugal Cicatricial Alopecia
Getting an accurate diagnosis quickly will give you the greatest chances of slowing, stopping and even reversing disease progression. The aim is to reduce inflammation, slow hair loss and preserve existing hair follicles. Effective treatment of central centrifugal cicatricial alopecia usually involves a combined medical and lifestyle approach. Treatment plans are usually tailored to the severity and progression of the disease. Below are the best known medical treatments for central centrifugal cicatricial alopecia:
- Topical Steroids: Usually the first-line treatment for CCCA, these medications help to suppress scalp inflammation, reduce itching and slow progression of follicular damage. Potent steroids like clobetasol propionate are often applied directly to the affected area once or twice daily. In some cases, your doctor may recommend combining topical steroids with a medicated shampoo or antifungal agent if there’s also evidence of seborrhoeic dermatitis or secondary scalp infection. Steroids are especially effective in the early or active inflammatory stages of CCCA when there is still a chance to prevent permanent scarring.
- Minoxidil: Although minoxidil does not treat the inflammatory component of CCCA, it is often used alongside anti-inflammatory therapies to support hair regrowth and improve hair density in areas that remain active but not yet scarred. Available orally or in topical solutions, minoxidil stimulates blood flow to the hair follicles and prolongs the growth phase of the hair cycle. This treatment is most beneficial for patients in the early stages of CCCA or those with mixed patterns of scarring and non-scarring hair loss.
- Metformin: Some doctors may also metformin off-label or in unlicensed compounded solutions. This medication is traditionally used for type 2 diabetes but studies show that metformin (both oral and topical) may have anti-fibrotic and anti-inflammatory effects in CCCA.
- Systemic Anti-Inflammatories: For moderate to severe cases or when topical treatments alone don’t work, oral medications may be necessary to control inflammation. Oral antibiotics like doxycycline or minocycline are frequently used due to their dual action as they reduce inflammation and help manage any bacterial imbalance on the scalp. In more resistant or rapidly progressing cases, immunomodulatory drugs such as hydroxychloroquine may help prevent follicular destruction.
- Intralesional Steroid Injections: This involves injecting a corticosteroid like triamcinolone acetonide directly into the affected areas of the scalp. These injections are usually given every 4–6 weeks and are particularly useful for reducing patches of inflammation, alleviating pain or tenderness and preventing the formation of new scar tissue.
- Advanced Hair Restoration Options: In advanced stages of CCCA where scarring has permanently destroyed hair follicles, treatment options become more limited. Hair transplants may be an option but only if the underlying inflammation is fully under control. This is because ongoing inflammation can compromise results. Another option is platelet-rich plasma (PRP) therapy, which involves injecting concentrated platelets from your own blood into the scalp. This can encourage healing and stimulate hair growth.
In order to support medical treatment and prevent further damage, it’s important to adopt a gentle haircare routine. The below steps will help prevent or slow down progression of central centrifugal cicatricial alopecia:
- Avoid Tight Hairstyles: Opt for looser styles that don’t pull on the scalp. This will reduce irritation and inflammation.
- Reduce Heat and Chemical Treatments: Minimise the use of relaxers, perms and heat styling tools.
- Scalp Care: Choose gentle nourishing haircare products and cleanse regularly with a mild shampoo to prevent build-up and inflammation. Consider using anti-inflammatory scalp oils or serums as advised by your doctor to boost scalp health and soothe irritation.
Central centrifugal cicatricial alopecia deserves a lot more attention than it gets. This progressive scarring condition can cause permanently hair loss if not treated early and effectively. The best treatments seek to reduce inflammation and prevent damage to the hair follicles. This should always be done in combination with adopting good haircare practices that protect and boost the health of the scalp.
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