Hair Breakage as a Presenting Sign of Early or Occult Central Centrifugal Cicatricial Alopecia

The document summarizes a study involving 9 African American women who experienced hair breakage at the vertex of the scalp, which was suspected to be an early sign of Central Centrifugal Cicatricial Alopecia (CCCA). Scalp biopsies confirmed CCCA in 5 out of the 8 patients with adequate samples, with 1 showing advanced stages of the condition. Two patients had premature desquamation of the inner root sheath, indicating early CCCA, while 1 had a normal biopsy. The study concluded that hair breakage could be an early indicator of CCCA in African American women and that histological evaluation is essential for diagnosis. Symptoms included pruritus in 78% of patients and scalp tenderness in 44%. Treatment outcomes varied, with 44% experiencing hair regrowth, 11% showing progression of hair loss, and 44% lost to follow-up. The study highlights the need to consider early CCCA in the differential diagnosis of hair breakage at the crown or vertex, even without visible scarring, to prevent disease progression.