Differentiating Between Central Centrifugal Cicatricial Alopecia, Traction Alopecia, and Alopecia Areata in Black Patients: Photographic Examples from a Clinical Trial

November 2024 in “ SKIN The Journal of Cutaneous Medicine ”

Amy McMicheal, Susan Taylor, Valerie Callender, Tiffany Mayo, Susan Ball, Fionn McSwiney, Najwa Somani, Chesahna Kindred

central centrifugal cicatricial alopecia traction alopecia alopecia areata scarring alopecia fringe sign scalp biopsy

TLDR Visual signs are crucial for accurately diagnosing and treating different types of hair loss in Black patients.

The study highlights the diagnostic challenges in differentiating between Central Centrifugal Cicatricial Alopecia (CCCA), Traction Alopecia, and Alopecia Areata (AA) in Black patients, using photographic evidence from a clinical trial. In the BRAVE-AA1 addendum 5 study, 36 patients' scalp photographs were reviewed, revealing that 33% were diagnosed with CCCA or other scarring alopecia, predominantly in females. Key diagnostic signs included scalp pigmentation changes for CCCA, the "fringe sign" for traction alopecia, and asymmetrical bald patches for AA. The study emphasizes that misdiagnosis can occur due to overlapping hair loss patterns, and while photographs aid in diagnosis, they are not definitive without biopsies. The findings underscore the importance of visual signs in tailoring treatment plans for alopecia in Black patients.

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