What is it?
A type of hair loss (alopecia) that destroys the hair follicles and replaces them with scar tissue, causing permanent hair loss.
- It is the inflammation (hot, red and swollen skin) that develop around the hair follicles (the roots within the scalp that produce the hair).
- These hair follicles are damaged and destroyed by the inflammation, eventually being replaced by fibrosis (scar tissue). Therefore, in the areas where the hair is lost there is no potential for the hair to regrow.
- This condition occurs mainly in women of African descent aged 30 to 40 years with hair that grows in tight curls.
- Men and children of African descent may also be affected but it is less frequently seen.
- This condition is also known as hot comb alopecia, follicular degeneration syndrome, and chemically induced cosmetic alopecia.
Diagnosis Tests
- Diagnosis is based on the history and clinical features (appearance), including the pattern of hair loss and appearance of the scalp skin and hair.
- Scalp biopsy.
Cause
Unknown, association of this condition to others includes:
- Genetic factors: Occur in several family members (with a link to mutations of the gene PADI3 that is essential to formation of the hair-shaft).
- Hair care practices: hair straightening using hot combs (straighteners) and chemical relaxers (lotion or cream to alter the hair texture), tight hairstyles, braids and weaves have all been suggested as increasing the risk of developing this condition; however, not all studies have found this link.
- Some people may have another cause of hair loss at the same time such as traction alopecia due to tight hairstyles.
- Autoimmune factors: when your own immune system does not recognise your hair follicles and tries to fight against them causing inflammation.
- Increased tendency to develop fibrosis (scar tissue); keloid scars (raised scars) and uterine fibroids (benign growths in a woman’s womb) are more common in women affected by CCCA.
- Diabetes type 2 (Increased risk of developing bacterial scalp infections)
- Folliculitis keloidalis nuchae
- Overweight and/or obese
- Pregnancy
- Seborrhoeic dermatitis
Vitamin, herbal and mineral
Symptoms
- Begins as as slight patch of hair thinning on the midline of the crown (top) of the scalp. Over time, the patch expands outwards in all directions (described as a centrifugal pattern) and the severity of hair loss increases, with the most severe hair loss remaining in the centre. This progression is usually very slow?
- Often there are no symptoms, some people may experience burning, tingling, itching, soreness, or tenderness of the scalp?
- Hair breakage may be an early sign before patches develop?
- Hair loss and hair breakage may also be seen at the front and sides of the hairline due to traction alopecia?
- Scalp that is exposed may appear shiny, especially when the hair follicles have gone?
- Shorter, finer hairs within the area of hair loss due to shrinkage of the hair follicle [usually the scalp skin looks normal, although in some people the skin may be more inflamed (identified by redness, pigment change and scaliness)]?
Complications /Information to beware of/General tips:
General tips
- Consider natural hairstyles. Recent research has found that patients wearing natural hairstyles have higher chances of this condition improving compared with patients not wearing natural hairstyles.
- Consider less use of all heated hair devices (hooded dryers, blow dryers, hot combs, and flat irons), avoid tight braids, weaves or extensions or any other hair practice that causes scalp discomfort or irritation.
- Hardening gels and sprays should be avoided as they increase the hair’s fragility.
- Relaxers should only be performed by a professional, no more frequently than every 6-8 weeks and to new hair growth only. The scalp should not burn as a result of relaxer application.
- Minimise heat application (hooded dryers, blow dryers, hot combs and flat irons)
- Avoid tight braids and weaves/extensions
- Avoid hair style practices associated with discomfort, scalp irritation or scale
- It is important for providers to know that frequency of shampooing the hair varies among Black women. Many shampoo every 1–2 weeks. This is the norm and prevents excessive dryness.
- It is important to protect any bald areas of your scalp from the sun to prevent sunburn and long-term sun damage. You should cover any bald patches with sun block or a hat if you are going to be exposed to sunlight for prolonged periods.
Treatments
- Response treatment is slow and will usually take at least six months before any effect can be seen.
This condition may show similar symptoms to:
Please talk to your healthcare professional (i.e. Medical Doctor/Pharmacist) for further advice
Detailed Information
Please copy and paste any key words from the title: Central centrifugal cicatricial alopecia in the following respective 'Medtick References and/or Sources' to find out more about the disease (this also may include diagnosis tests and generic medical treatments).
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References
- British Association of Dermatologists (BAD)
- Callender V, Wright D, Davis E, Sperling L. Hair Breakage as a Presenting Sign of Early or Occult Central Centrifugal Cicatricial Alopecia Clinicopathological Findings in 9 patients. Archives of Dermatology. 2012;148(9):1047-1052.
- Dlova, N, Forder, M. Central centrifugal cicatricial alopecia: possible familial aetiology in two African families from South Africa. International Journal of Dermatology 2012, 51 (Suppl. 1): 17–20
- Gathers RC, et al. Hair grooming practices and central centrifugal cicatricial alopecia. Journal of the American Academy of Dermatology 2009; 60:574-8
- Kyei A, Bergfeld WF, Piliang M, Summers P. Medical and environmental risk factors for the development of central centrifugal cicatricial alopecia: a population study. Arch Dermatology. 2011;147(8):909-914
- Olsen EA, et al. Central hair loss in African American women: Incidence and potential risk factors. Journal of American Academy of Dermatology 2011;64:245-52.
- Olsen EA, et al. Central scalp alopecia photographic scale in African American women. Dermatol Ther 2008;21:264-7.
- Summers P, Kyei A, Bergfeld W. Central Centrifugal Cicatricial Alopecia – an approach to diagnosis and management. International Journal of Dermatology 2011; 50: 1457-1464.
- Whiting DA, Olsen EA. Central centrifugal cicatricial alopecia. Dermatologic Therapy 2008;21:268-278Malki L, Sarig O, Romano MT, Méchin MC, et al. Variant PADI3 in Central Centrifugal Cicatricial Alopecia. N Engl J Med. 2019 Feb 28;380(9):833-841. doi: 10.1056/NEJMoa1816614. Epub 2019 Feb 13. PubMed PMID: 30763140.
