In this video blog, Susan Taylor, MD, discusses highlights from her lecture Central Centrifugal Cicatricial Alopecia on July 25, 2024, during the inaugural Elevate-Derm Alliance Summer Conference at the Westin Copley Place in Boston, Massachusetts.
In this video
Dr. Taylor stresses that because CCCA is a chronic scarring alopecia, diagnosing it as fast as possible is critical — once follicles are scarred, "we can't really bring them back." She points to two early tip-offs: breakage of the hair in the vertex area of the scalp, and symptoms like tenderness, soreness, or a lot of itching. Either should prompt a dermatoscopic exam or a biopsy. When biopsying, she cautions against sampling the central area of scarring and instead aiming toward the periphery, where the dermatopathologist can catch the perifollicular lymphocytic infiltrate that helps clinch the diagnosis.
She reviews the comorbidities associated with CCCA — including diabetes or pre-diabetes, breast cancer, some autoimmune disorders, and uterine leiomyomas — plus anxiety and depression, which she sees as an opportunity to refer patients for counseling or support groups. And she reassures clinicians that it's essentially never too late: while she can't guarantee new hair, active disease can be stopped, and some patients are pleasantly surprised by regrowth.
- Diagnose CCCA early — once follicles scar, they can't be recovered.
- Think CCCA when a patient reports hair breakage at the vertex, or scalp tenderness, soreness, or itching, and act with a dermatoscopic exam or biopsy.
- Biopsy the periphery, not the central scarred area, so pathology captures the active perifollicular lymphocytic infiltrate.
- Screen for comorbidities: diabetes/pre-diabetes, breast cancer, autoimmune disorders, uterine leiomyomas, and anxiety/depression.
- It's never too late — active disease can be stopped, and regrowth is sometimes possible, so try for every patient.
