ABSTRACT
Central centrifugal cicatricial alopecia (CCCA) is a chronic and progressive cicatricial alopecia, which manifests as hair loss on the vertex of the scalp with gradual, centrifugal spread. CCCA predominantly affects middle-aged women of African ancestry and the prevalence of CCCA in this population is believed to range from 2.7% to 5.6%. The pathogenesis of CCCA is poorly understood and the etiology is likely multifactorial. Presently, two hypotheses exist. In the first hypothesis, the inner root sheath, a structure that envelops and protects the hair shaft, is prematurely desquamated in the early phase of CCCA. The second hypothesis suggests CCCA is a fibroproliferative disorder due to the predominant role of fibrosis in the disease process. A scalp biopsy may be needed to help distinguish CCCA from other cicatricial alopecias. Successful treatment of CCCA should focus on suppressing and preventing ongoing inflammation, deterring scar formation, alleviating symptoms, and if possible, promoting hair regrowth.
