central hair loss
Central centrifugal cicatricial alopecia (CCCA) is a primary inflammatory condition that previously held the names of “hot comb alopecia,” “follicular degeneration syndrome,” “pseudopelade” and “central elliptical pseudopelade.” CCCA primarily affects the vertex/crown scalp and progressively spreads down the top of the scalp over time.
The causes of CCCA have been speculated but not proven. One study performed by Dr. McMichael1 showed patients affected by CCCA had a history of hair weaving and a long duration of chemical relaxer usage compared to unaffected individuals. However, a more recent study in 2011 by Olsen et al showed no obvious association of general central hair loss with relaxer or hot comb use, history of seborrheic dermatitis (dandruff article) or a reaction to a hair care product, bacterial infection, or male pattern hair loss in fathers of those affected2.
CCCA can mimic other hair loss disorders including female pattern hair loss and requires definitive diagnosis and medical intervention. CCCA typically affects women but also men of primarily African descent. Patients present with an itchy, tender, and scaly scalp with areas of tight shiny skin where hair follicles have been destroyed and replaced with scar tissue. The condition is slowly progressive and severe cases can progress to involve the entire scalp. Awareness of this condition is important due to symptoms going unnoticed for a long time. The most common early signs are hair breakage, itching, scalp tenderness in the affected area.
If diagnosed early, medical intervention can stop the progression of the condition. Topical steroids, antibiotics and other anti-inflammatory medications are used to calm down the inflammation targeting the follicles and the sebaceous glands (anatomy of a follicular unit).
- Review Ethnic hair update: past and present. McMichael AJ. J Am Acad Dermatol. 2003 Jun; 48(6 Suppl):S127-33.
- Olsen EA, Callender V, McMichael A, Sperling L, Anstrom KJ, Shapiro J, et al. Central hair loss in African American women: Incidence and potential risk factors. J Am Acad Dermatol. 2011;64:245–52.