Hair loss types: Central centrifugal cicatricial alopecia treatment

If you think you might have this type of hair loss, see a dermatologist ASAP

Caught early, treatment can prevent further hair loss and possibly help you regrow some hair.

How do dermatologists diagnose central centrifugal cicatricial alopecia (CCCA)?

It takes time and expertise to diagnose this type of hair loss, so it’s important to see a dermatologist and keep your appointments. Getting an accurate diagnosis and proper treatment can prevent further hair loss.

To find out if you have CCCA, your dermatologist will:

• Examine your hair and scalp closely.

• Ask how long you’ve noticed the hair loss and whether you have any symptoms like itching or tenderness on your scalp.

• Ask about your health, medical conditions, and medications.

• Talk with you about your hair care and hairstyles.

If your dermatologist suspects that you have CCCA, you may need a scalp biopsy. Your dermatologist can perform this procedure during an office visit while you remain awake. To perform a scalp biopsy, your dermatologist will numb part of your scalp and remove a small bit of skin.

The skin that your dermatologist removes will be examined under a microscope. This microscopic view is essential. It helps to make sure that you have CCCA. It can also find another type of hair loss. Some women who have CCCA have a second type of hair loss like traction alopecia or female-pattern hair loss as well.

Gathering all the necessary information takes time, often several weeks. It’s worth the wait. Having all this information allows your dermatologist to tailor your treatment plan to your needs.

How do dermatologists treat CCCA?

To create the best treatment plan for you, your dermatologist will consider your individual needs.

The goals of treatment are to:

• Stop – or slow – hair loss.

• Relieve symptoms if you have any.

• Regrow hair when possible.

Here’s what a treatment plan for CCCA may include:

Medication to prevent further hair loss: To prevent hair loss from continuing, treatment begins with medication that can reduce inflammation quickly. Reducing inflammation can also help relieve symptoms.

Many patients begin treatment by using a medication known as a corticosteroid. Corticosteroids help reduce inflammation. Your dermatologist may prescribe one that you’d apply to your scalp at home. To start, you’d apply it every day for two to four weeks. Then, you may taper off to a few times a week.

Some patients receive injections of corticosteroids. If this is part of your treatment plan, you’d go to your dermatologist’s office for these injections. Many patients receive monthly injections, usually for six to eight months.

Another medication that can help reduce inflammation is an antibiotic like doxycycline or minocycline. Your dermatologist may prescribe an antibiotic that you apply to your scalp or take as a pill. You would apply — or take — this medication for two to six months. That’s about how long it takes to reduce the inflammation. Then your dermatologist will reduce the dosage and later stop prescribing it.

Another medication that can reduce inflammation is called a calcineurin inhibitor. If this is prescribed, you would apply it to your scalp at home.

The hair-regrowth medication called minoxidil may also be part of your treatment plan. If it is, you’d apply it to your scalp once or twice a day.

Minoxidil is always used along with other medications. Using only minoxidil cannot treat CCCA effectively.

Treating CCCA at home with minoxidil alone cannot prevent further hair loss

To halt hair loss, you need prescription medication that can reduce inflammation.

To prevent further hair loss, dermatologists often prescribe more than one medication. Treating CCCA this way can improve results and reduce possible side effects. For example, to prevent further hair loss, a treatment plan could involve:

• Applying a corticosteroid that your dermatologist prescribes, using it at home as directed

• Going to your dermatologist’s office for injections of corticosteroids

• Starting minoxidil (2% or 5%), applying it to your scalp once or twice a day

Once CCCA stabilizes, your dermatologist will change your treatment plan. You will no longer need powerful anti-inflammatory medication.

If you notice CCCA early, treatment may help you regrow some hair

With late-stage CCCA, a dermatologist can help by relieving your symptoms, preventing more hair loss, and giving you advice about hairpieces, wigs, and techniques to hide hair loss.

Dandruff shampoo to treat the scale: If CCCA has caused scaling on your scalp, a dandruff shampoo can treat this. Your dermatologist will recommend a shampoo and tell you how often to use it.

Healthy hair care practices: While a connection between developing CCCA and wearing certain hairstyles has not been proven, it is important to follow healthy hair care practices. This helps to reduce inflammation and prevent another type of hair loss like traction alopecia.

Healthy hair care can also give you the best overall outcome from your medical treatment. Healthy hair care practices that your dermatologist may recommend include:

• Wear loose rather than tight hairstyles, such as loose rather than tight braids.

• Skip hairstyles that irritate your scalp or cause hair breakage.

• Reduce tension on your scalp by no longer getting weaves and extensions.

If you feel uncomfortable with these recommendations, tell your dermatologist. Dermatologists understand that a hairstyle change may not be an option for everyone.

When possible, your dermatologist will recommend some changes that will allow you to continue wearing a hairstyle while reducing damage.

For example, if you plan to keep using a relaxer, your dermatologist can offer tips to reduce the stress on your hair. These tips include getting fewer chemical relaxer treatments and going to a professional stylist for your relaxer.

Dermatologists continue to study treatment options for CCCA

Treatment that works for one patient may be ineffective for another patient.

To provide their patients with the best treatment for CCCA, dermatologists continue to look for treatment that can consistently deliver results.

Some treatments that dermatologists are exploring as a possible treatment for CCCA include:

• Platelet-rich plasma (PRP)

• Metformin, a cream-form of this diabetes medication, which can be applied to the scalp

• Testing for type 2 diabetes and treating it

These treatments have effectively treated a few women with CCCA. There’s still much to work out with the above treatments, so they’re considered experimental. Your dermatologist may recommend one if other treatments fail to work.

Along with medication, your dermatologist will recommend self-care. You’ll find tips for doing this at Central centrifugal cicatricial alopecia: Self-care.

Images
Images 1,3,4: Getty Images

Image 2: Property of the American Academy of Dermatology

References
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Herskovitz I, Miteva M. “Central centrifugal cicatricial alopecia: Challenges and solutions.” Clin Cosmet Investig Dermatol. 2016 Aug 17;9:175-81.

Heymann, WR. “Striving to alleviate the physical and emotional scars of central centrifugal cicatricial alopecia.” In: Dermatology World Insights and Inquiries. 11/4/2020. Last accessed 3/26/2021.

Ogunleye TA, Quinn CR, et al. “Alopecia.” In: Taylor and Kelly’s Dermatology for Skin of Color. (second edition). McGraw Hill, USA, 2016:254-5.

Okereke UR, Simmons A, et al. “Current and emerging treatment strategies for hair loss in women of color.” Int J Womens Dermatol. 2019;5(1):37-45.

Roche FC, Harris J, et al. “Association of type 2 diabetes with central centrifugal cicatricial alopecia: A follow-up study.” J Am Acad Dermatol. Article in Press. Last accessed 3/26/2021.

Shahriari N, Hochman E, et al. “Poster 15244: Central centrifugal cicatricial alopecia: An outcomes study.” J Am Acad Dermatol. 2020;83(6):AB32. No commercial support identified.

Written by:
Paula Ludmann, MS

Reviewed by:
Crystal Aguh, MD, FAAD
Erin McKinley Ducharme, MD, FAAD
Shani Francis, MD, MBA, FAAD
Carrie L. Kovarik, MD, FAAD
Shari Lipner, MD, PhD, FAAD
Benjamin Stoff, MD, FAAD

Last updated: 3/14/22

All content solely developed by the American Academy of Dermatology

The American Academy of Dermatology gratefully acknowledges support from the following companies: