Central Centrifugal Cicatricial Alopecia (CCCA)

Central Centrifugal Cicatricial Alopecia (CCCA) is the most common cicatricial alopecia in African American women, characterized by chronic and progressive central scalp hair loss that starts on the crown and spreads peripherally, sparing the lateral, frontal, and posterior scalp. Symptoms can range from none to soreness, itching, and burning. Early cases can be difficult to distinguish from androgenetic alopecia, making pathology crucial for diagnosis. CCCA can present as interconnected alopecic patches with a maze-like appearance. It can be inherited in an autosomal dominant fashion, with a strong modifying effect of hairstyling and sex. Upregulation of genes implicated in fibroproliferative disorders has been detected in patients with CCCA, and the prevalence of PADI3 mutation was higher among patients with CCCA than in a control cohort of women of African ancestry. Trichoscopy reveals specific features such as the peripilar gray/white halo, irregular honeycomb-pigmented network, irregularly distributed pinpoint white dots, hair shaft variability, and white patches that represent follicular dropout.