50-Year-Old Female with a Burning Scalp and Hair Loss

Central Centrifugal Cicatricial Alopecia (CCCA) is a primary, scarring, lymphocytic alopecia that primarily affects middle-aged females of African descent. The hair loss pattern begins at the vertex of the scalp and progresses in a symmetric centrifugal pattern, leading to irreversible scarring and loss of follicular pores. The cause is unknown, but it is believed to be influenced by genetics, grooming habits, and environmental factors that trigger an inflammatory response leading to scarring. Diagnosis is made through clinical presentation and characteristic dermatoscopic findings, with possible use of biopsy. Management includes early intervention with medications, patient education, and psychosocial support. Topical treatments include corticosteroids, tetracyclines, minocycline, calcineurin inhibitors, anti-seborrheic shampoos, and minoxidil. Other treatments being explored include apremilast, gabapentin, clobetasol propionate, and JAK inhibitors. Invasive procedures like hair transplants are considered last-line therapy. Non-pharmacological methods such as camouflaging with hair pieces, wigs, and scalp micropigmentation can also be beneficial.