Central Centrifugal Cicatricial Alopecia in Patients with Darker Skin

00:01 Let's now talk about central centrifugal cicatricial alopecia (CCCA).

00:08 This is a scarring alopecia that presents as an area of permanent hair loss on the crown or vertex of the scalp.

00:16 It predominantly affects adult women of African descent, with a female-to-male ratio of about 3 to 1.

00:23 It usually presents in middle-aged women.

00:27 The etiology is still not fully understood, but it's possible multifactorial due to a combination of hair practices and genetics.

00:38 The PADI3 gene has been identified as one of the genes that could be triggering CCCA and of course, other factors.

00:49 Clinically, it presents with hair loss that primarily involves this area , the crown. It's symmetric and spreads centrifugally.

01:00 It can be asymptomatic or followed by painful papules, pustules, and tender scalp lesions of very mild pruritis.

01:10 On examination of the scarred area, one sees lack of follicular openings.

01:19 The way we classify CCCA, we use the Olsen severity score for classification, which you can see on the slide.

01:31 The diagnosis is made on history and is helpful for ruling out other head disorders.

01:40 Physical examination entails looking for loss of follicular ostia and other inflammatory lesions. The biopsy is usually needed for CCCA to confirm the clinical diagnosis, and on histology one finds permanent loss of the follicles, premature desquamation of the inner root sheath and concentric lamellar fibroplasia around the hair follicle, particularly at the level of the follicular isthmus and lower infundibulum.

02:16 The differential diagnosis includes discoid lupus erythematosus.

02:20 Biopsy may be needed here, and DLE tends to have telangiectasia as well as scaling. Lichen planopilaris is another differential, particularly for the type of lichen planus that occurs on the crown.

02:35 The biopsy is needed for this, and of course trichoscopy is helpful because one's is perifollicular plugging and erythema.

02:45 Female pattern hair loss is a differential, particularly for the reason that these conditions occur on the same area of the scalp.

02:56 And here there's absence of scarring and visible follicular ostia, and one does not see the perifollicular plugging.

03:05 The management goals include promoting of hair growth, and this can occur especially if this is diagnosed early.

03:15 Where there is complete hair loss, it may be difficult to grow the hair back.

03:22 Sometimes we advise patients that we're able to keep the hair that they've got.

03:27 However, it may be difficult to grow the hair where the follicles have been damaged.

03:35 What we use for treatment are anti-inflammatory agents as a first line of therapy, as listed on the slide.

03:45 Tetracyclines are useful because they are anti-inflammatory.

03:50 When the disease is bent out and the patient has been on treatment for some time, sometimes hair transplantation can be offered for patients, but at times it helps to do a small patch area and see how the hair grows.