Pathologic Diagnosis of Central Centrifugal Cicatricial Alopecia on Horizontal Sections

September 2014 in “ American Journal of Dermatopathology ”

Mariya Miteva, Antonella Tosti

Central Centrifugal Cicatricial Alopecia CCCA follicular miniaturization inner root sheath desquamation sebaceous glands compound follicular structures perifollicular fibrosis perifollicular inflammation lamellar hyperkeratosis parakeratosis naked hair shafts goggles sign hair follicle shrinkage hair follicle structures fibrosis around hair follicles inflammation around hair follicles thickened skin layers skin cell retention exposed hair shafts

TLDR Horizontal sections of scalp biopsies are good for diagnosing Central Centrifugal Cicatricial Alopecia and help customize treatment.

The study analyzed scalp biopsies from 51 African-American women with Central Centrifugal Cicatricial Alopecia (CCCA) using horizontal sections to identify pathologic features. Key findings included follicular miniaturization in 81% of cases, premature desquamation of the inner root sheath in 96%, preservation of sebaceous glands in 94%, compound follicular structures with perifollicular fibrosis and/or inflammation in 89%, lamellar hyperkeratosis/parakeratosis in 79%, absent or mild inflammation in 77%, and naked hair shafts in 68%. The study concluded that horizontal sections are effective for diagnosing CCCA, especially in early or focal disease, and provide detailed information for tailoring treatment. It also suggested that hair breakage might trigger CCCA and highlighted the "goggles" sign and the preservation of sebaceous glands as important diagnostic features.

View this study on journals.lww.com →

Discuss this study in the Community →

Research cited in this study

12 / 12 results

research A Comprehensive Approach to Hair Pathology of Horizontal Sections

12 citations, June 2013 in “The American Journal of Dermatopathology”

A new method using visual aids to diagnose hair diseases was effective after brief training.

research Follicular Density and Ratios in Scarring and Nonscarring Alopecia

19 citations, February 2013 in “The American Journal of Dermatopathology”

Nonscarring alopecia has higher hair density than scarring alopecia, and hair density can help diagnose the type of alopecia.

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

44 citations, September 2012 in “Archives of Dermatology”

Hair breakage may be an early sign of a hair loss condition called CCCA in African American women.

research A Detective Look at Hair Biopsies from African-American Patients

40 citations, May 2012 in “British Journal of Dermatology”

Recognizing specific features of African-American hair can help diagnose hair loss conditions.

research Prevalence and Etiology of Central Centrifugal Cicatricial Alopecia

19 citations, August 2011 in “Archives of Dermatology”

CCCA is a common scarring hair loss in African descent women, possibly linked to genetics, hair care practices, and health issues like diabetes.

research Sebaceous Gland Loss and Inflammation in Scarring Alopecia: A Potential Role in Pathogenesis

37 citations, June 2011 in “Journal of The American Academy of Dermatology”

Loss of sebaceous glands and inflammation may contribute to the development of scarring alopecia.

research Medical and Environmental Risk Factors for the Development of Central Centrifugal Cicatricial Alopecia

88 citations, April 2011 in “Archives of Dermatology”

Type 2 diabetes, bacterial scalp infections, and tight hairstyles like braids and weaves are linked to a higher risk of a scarring hair loss condition in African American women.

research Central Hair Loss in African American Women: Incidence and Potential Risk Factors

76 citations, November 2010 in “Journal of The American Academy of Dermatology”

Some African American women's central scalp hair loss is linked to genetics and past fungal scalp infections, with more research needed on other causes.

research Central Scalp Alopecia Photographic Scale in African American Women

46 citations, July 2008 in “Dermatologic Therapy”

A scale was made to measure hair loss severity in African American women.

research Female Pattern Hair Loss and Its Relationship to Permanent/Cicatricial Alopecia: A New Perspective

73 citations, November 2005 in “Journal of Investigative Dermatology Symposium Proceedings”

Some women with common hair loss may develop permanent hair loss.

research Hair Density in African Americans

129 citations, June 1999 in “Archives of Dermatology”

African Americans have less hair density than whites.

research Diagnostic and Predictive Value of Horizontal Sections of Scalp Biopsy Specimens in Male Pattern Androgenetic Alopecia

309 citations, May 1993 in “Journal of The American Academy of Dermatology”

Horizontal scalp biopsy sections effectively diagnose and predict MPAA, with follicular density and inflammation impacting hair regrowth.

Related Community Posts Join

6 / 59 results

community Diffuse hair loss and scalp biopsies

in Research 692 upvotes 4 months ago

Scalp biopsies are crucial for diagnosing hair loss conditions like Diffuse Unpatterned Alopecia (DUPA) and retrograde hair loss, as treatments like finasteride and dutasteride may not be effective if other conditions are present. Combining PPAR-GAMMA agonists with retinoids could improve treatments for conditions like Lichen Planopilaris.

community lost my hair in a single year of treatment at 20 years old

in Finasteride/Dutasteride 89 upvotes 4 months ago

A 20-year-old lost significant hair after one year of treatment, using minoxidil, finasteride, and later dutasteride. They are considering adding RU58841 but are advised to return to finasteride and minoxidil for a year before deciding.

community I am a dermatologist with a clinical interest in alopecia. AMA

in Will treatment work for me? 2 years ago

In this conversation, 4990 discussed various treatments for hair loss, including oral minoxidil, PRP, transplan, Jak inhibitors, Dutasteride, Finasteride, Olumiant, Ketoconazole, RU58841, microneedling, baricitinib, and CCCA. They recommended scalp biopsies in unclear cases of DUPA, twice weekly to twice daily shampooing for topical minoxidil users, and two sessions spaced one month apart with follow up at month three to determine the effectiveness of PRP treatment.

community Wanted to say that Derma rolling and Pumpkin seed oil helped my crown out.

in Treatment 4 upvotes 5 years ago

Derma rolling, pumpkin seed oil, and daily massages helped regrow weak hairs on the crown. Nizoral shampoo and yoga also contributed to reducing scalp pain and stress.

community Finasteride doesn't work for me in 2 years and my bloodtest result just came in.

in Progress Pictures 88 upvotes 1 year ago

A user has been treating hair loss with finasteride for two years without success and is experiencing an itchy scalp with seborrhea. Despite low DHT levels, they are still losing hair, suggesting that DHT might not be the main cause of their hair loss, and they are considering other treatments or causes.

community Exploring Bryan Johnson's Hair Routine In Detail

in Research/Science 64 upvotes 11 months ago

Bryan Johnson uses a custom hair loss treatment that includes topical finasteride, minoxidil, azelaic acid, diclofenac, tea tree oil, rosemary oil, ginkgo biloba, biotin, and melatonin, which have shown varying degrees of effectiveness with minimal side effects. He also undergoes PRP and laser therapy, and has tried dutasteride mesotherapy.

Related Research

4 / 4 results

Body to Scalp: Evolving Trends in Body Hair Transplantation

research Hair Counts from Normal Scalp Biopsy in Taiwan

24 citations, September 2012 in “Dermatologic Surgery”

The conclusion is that normal scalp hair counts for Taiwanese people were established, showing age-related differences but not sex or scalp location differences.