From the Journals

Central centrifugal cicatricial alopecia can affect adolescents



Central centrifugal cicatricial alopecia (CCCA) can affect adolescents, and a study of six biopsy-proven cases indicates CCCA has a genetic component, Ariana N. Eginli and her colleagues report in Pediatric Dermatology.

CCCA, a scarring alopecia that disproportionately affects middle-aged women of African descent, has been attributed to hair care and styling practices. In this series, however, five of the six patients had a maternal history of CCCA, and only one had used chemical products or styling tools. “Specifically, the early onset of CCCA in these patients with natural virgin hair raises the possibility of genetic anticipation,” wrote Ms. Eginli of Wake Forest Baptist Health, Winston-Salem, N.C., and her coauthors. “Therefore, recognizing that CCCA can present in children, particularly in those with a positive family history, is of utmost importance in controlling further disease progression and improving their quality of life.”


This adult patient has central centrifugal cicatricial alopecia.

The authors described four patients treated at the Hair Disorder Clinic at Wake Forest and two treated between 2012 and 2015 at the Nelson R. Mandela School of Medicine, Durban, South Africa. Tender scalp papules, pruritus, and scaling of the scalp were among the presenting symptoms, in addition to hair loss. Histology confirmed CCCA in all six patients, who were diagnosed at ages 14-19 years. Five of the six patients had a family history of CCCA (Pediatr Dermatol. 2017 Mar;34[2]:133-7). Family history was not known for the sixth adolescent, who was adopted, .

Two patients had previously undergone scalp surgery, specifically ventriculoperitoneal shunt placement, years before their hair loss began. The authors speculated that the scalp surgery may have contributed to the early development of CCCA.

“We recommend that clinicians check for early signs of CCCA when there are complaints of hair loss on the scalp of offspring of affected women of African descent,” they wrote. “If there is any clinical suspicion of CCCA or any scarring alopecia, a scalp biopsy should be performed.”

Ms. Eginli had no disclosures. One of her colleagues is a consultant for and has received grant support from various drug companies.

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