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What is it?
Central (begins in the middle or central portion of the scalp); Centrifugal (the hair loss radiates outward on the scalp in a centrifugal fashion); Cicatricial (scarring of the hair follicles); Alopecia (hair loss).
CCCA is a hair disorder that leads to destruction of hair follicles, scarring and permanent hair loss (alopecia). This condition is seen most frequently in African-American women. It can progress very slowly with gradual hair loss with no symptoms or rapidly with tingling, burning, pain or itching of the scalp. CCCA is not contagious.
What causes it?
The cause is poorly understood, but there may be a hereditary predisposition. It is suspected that this type of alopecia may be related to hair care practices such as improper chemical treatments (relaxers and hair dyes), excessive heat or chronic tension on the hair follicles from braids, extensions, weaves or curlers. Another suspected cause is inflammation of the hair follicle If the hair follicle is chronically inflamed, it will be destroyed, which leads to scarring in the follicle and permanent hair loss. This is why early detection is so important.
How is it diagnosed?
The best way to diagnose this condition is with a scalp biopsy. A biopsy is necessary to determine if inflammation is present,, the location of the inflammation and the amount of inflammation. The inflammation is not visually seen on the scalp. Therefore, a deeper look into the follicle with a biopsy is necessary for diagnosis.
How is it treated?
Treatment is based on the outcome of the biopsy. Unfortunately, there is no known cure for this condition and some people may develop permanent hair loss. Because little is known about this condition, there is no one specific treatment. If inflammation is seen on the biopsy, your doctor may treat you with oral antibiotics because they decrease inflammation (Doxycycline, Rifampin, Keflex/Cephalexin), topical antibiotics (Bactroban/Mupiricin) and topical anti-inflammatory creams (corticosteroids like Clobetasol/Vanos or Halbetasol/Ultravate). After the initial treatment period, Rogaine/Minoxidil is recommended to help hair re-growth (if permanent scarring has not occurred). A segment of the population may be sensitive to one of the ingredients in Rogaine, called propylene glycol. A propylene glycol-free Minoxidil product has been created and may be purchased in this office.
What should be avoided?
Because certain hair treatments have been implicated as possible causes of CCCA, we recommend minimizing the use of chemical relaxers, weaves, tight braids and heat to the hair and scalp. When using hair oils, pomades or grease, avoid the scalp and apply just to the hair. You may consider wearing a wig for a period of time. Tell your doctor if scalp symptoms return or if bumps develop.
Are there support organizations for people with Cicatricial or Scarring Alopecias?
Cicatricial Alopecia Research Foundation, www.carfintl.org
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