It is very important to me as a woman of color and as a dermatologist to try to help women understand more about the devastating disorder, alopecia. My goal is also to help you avoid hair loss, particularly the types that are easily preventable and treatable. Regrettably, there are several types of hair loss that we don't understand enough about and, therefore, we are unable to prevent them. In some cases, there is treatment for the specific type of hair loss but it must be started as early as possible. Central Centrifugal Cicatrical Alopecia (CCCA) is just one of these types. Even if you have not previously heard of CCCA, you probably know women who have this type of alopecia. Please send them the link to this post so that they will be better informed and hopefully seek help as quickly as possible.
Central Centrifugal Cicatrical Alopecia (CCCA) is hair loss (alopecia) that begins in the central (vertex) portion of the scalp. The hair loss then progresses or radiates outward in a centrifugal fashion. This type of hair loss causes scarring (cicatrix) of the hair follicles. Once a follicle is scarred it is destroyed and hair will never grow from that follicle again. When you look at the scalp, it may appear shiny and often you will not see holes or hair follicles. CCCA usually starts with a small patch of hair loss that may progress over months or years. If it goes untreated, the hair loss can become extensive which can be devastating for many women.
Sadly, when some women begin to experience the hair loss in the central portion of the scalp, they will attempt to camouflage the area instead of running (not walking) to the dermatologist. Often sewn-in or glued-in weaves or tight braids with extension will cause a different kind of damage and further hair loss. At the very least, camouflaging allows women to forget or ignore the alopecia as it insidiously worsens.
Some women experience tenderness or soreness of the scalp in the area of hair loss due to CCCA. Others report intense itching or a "pins and needles" type sensation. Still others will experience a burning or a "funny feeling" in the area of hair loss. If you experience any of these symptoms, even if you are not sure that you have hair loss, a visit to a dermatologist knowledgeable in hair loss is important.
CCCA is most commonly seen in black women and it can occur at any age. I have seen women as young as 15 and as old as 75 with CCCA. The cause of the condition is unknown. Some dermatologists think that CCCA may be inherited and passed from one generation to another. Others feel that hair care practices, such as chemical and heat based straightening of the hair, or pulling of the hair (traction) may be the cause of the condition. There are some who believe that the cause is multiple factors. What is agreed upon is that more research is needed to understand the underlying cause of this disorder.
The diagnosis of CCCA is made by performing a scalp biopsy and analyzing the hair follicles obtained under the microscope. You should not be afraid of a scalp biopsy. It is performed in the doctor's office, takes 20-30 minutes and you may resume your normal activities immediately after the procedure is completed. Topical medication is given so that the procedure will not be painful.
To perform a scalp biopsy, a small area of the scalp is numbed with Novocain or lidocaine and a tiny, 4 mm piece of the scalp is removed. A stitch is placed to close the area so that you will not have a patch of missing scalp. The small piece of scalp is sent to the laboratory to be analyzed under the microscope.
When the pathologist looks at the hair follicles under the microscope, he or she sees cells from the body, called lymphocytes, surrounding the hair follicles. The lymphocyte cells cause inflammation in the scalp. It is felt that the inflammation scars or destroys the follicles. Once a follicle is destroyed, the hair will never grow again. The pathologist will also see scar tissue in the scalp biopsy of someone with CCCA. It is critically important to stop the inflammation as soon as possible so that more follicles will not be destroyed.
The treatment of CCCA is designed to stop the inflammation and hence, further hair loss. There is no guarantee that new hair will grow especially if many follicles have been destroyed. There is no single agreed upon therapy for the treatment of CCCA and no therapy has been proven to be effective in all people. Oral and topical antibiotics are often prescribed for a four to six month period of time because they decrease inflammation. Topical or injected steroids are often applied directly to the scalp, again for a 4 to 6 month period. During the treatment, the symptoms of soreness, tenderness, itching, burning or "pins and needles" sensation stops. The hair loss will slow down and stop. Some lucky women may notice some re-growth of hair although.
What should you do if you think that you may have hair loss? First, call your dermatologist today! If you don't have one, visit the "Find a Doctor" portion of the website of the American Academy of Dermatology. Secondly, when you visit your dermatologist, have a list of your medications, allergies, medical conditions and your hair care practices (for example: relaxers for 20 years, hot combs for 10 years, no weaves, braids with extensions for two years and natural styles for the last 5 years). Do not be afraid if your doctor suggests blood test, a scalp biopsy or culture. These procedures are recommended so that the doctor can determine the type of hair loss that you have and treatment can be started.
This is the second installment of a three part series on hair loss.
Susan C. Taylor, MD