Central Centrifugal Cicatricial Alopecia Presenting with Irregular Patchy Alopecia on the Lateral and Posterior Scalp

Abstract

Background: Central centrifugal cicatricial alopecia (CCCA) is the most common cause of scarring alopecia among women of African descent which affects the central scalp and spreads centrifugally but spares the lateral and posterior scalp. Objectives: The objective of this study is to report on a new clinical variety of CCCA presenting with patchy alopecia involving the lateral and posterior scalp in addition to the central scalp. Materials and Methods: We reviewed the medical records and the clinical, dermatoscopic and pathologic data of 14 African-American women with CCCA presenting with patchy alopecia. Results: Two patients had individual well-delineated patches of hair loss, and 12 patients had multiple irregular patches of hair loss. In all cases, the alopecia affected the lateral and posterior scalp in addition to the central scalp. Four patients had a history of traumatic hairstyles, and 10 patients were also affected by marginal traction alopecia. On dermatoscopy, the patches showed peripilar white-gray halos and broken hairs. The pathologic diagnosis of CCCA was based on the following features: follicular dropout, absent or only focally preserved sebaceous glands, premature desquamation of the inner root sheath and perifollicular fibrosis with mild inflammatory infiltrate. Conclusion: CCCA can present with patches of hair loss involving the parietal and posterior scalp in addition to the central scalp. Without dermatoscopy and pathology, this variety can be easily misdiagnosed as traction alopecia.

Trichoscopy of Dark Scalp

“…Other dermoscopic features of CCCA include hair shaft variability, perifollicular erythema, broken hairs as black dots inside the follicular opening or as short broken shafts, pigmented asterisk-like macules with sparse terminal and vellus-like hairs, and scattered white patches [4,[62][63][64] (Fig. 8).…”

Trichoscopy of primary cicatricial alopecias: an updated review

“…Interestingly, all three studies came from the same authors—Miteva and Tosti and we think that the cases in these studies may be overlapping. The most frequent trichoscopic findings in these studies were honeycomb pigmented network, peripilar white halo, pinpoint white dots, terminal hairs, vellus hairs, white patches, erythema and scaling . The less frequent features which included asterisk‐like brown blotches, broken hairs and dark peripilar halo were highly specific for CCCA (>90% specificity for all three features) .…”

“…Central centrifugal cicatricial alopecia (CCCA) is more common among African American women and presents clinically as a central area of progressive hair loss over vertex expanding towards the periphery . Only three studies describing the trichoscopy of CCCA were found . Interestingly, all three studies came from the same authors—Miteva and Tosti and we think that the cases in these studies may be overlapping.…”

“…2 Only three studies describing the trichoscopy of CCCA were found. 18,50,51 Interestingly, all three studies came from the same authors-Miteva and Tosti and we think that the cases in these studies may be overlapping. The most frequent trichoscopic findings in these studies were honeycomb pigmented network, peripilar white halo, pinpoint white dots, terminal hairs, vellus hairs, white patches, erythema and scaling.…”

“…The most frequent trichoscopic findings in these studies were honeycomb pigmented network, peripilar white halo, pinpoint white dots, terminal hairs, vellus hairs, white patches, erythema and scaling. 18,50,51 The less frequent features which included asterisklike brown blotches, broken hairs and dark peripilar halo were highly specific for CCCA (>90% specificity for all three features). 50 Among all these features, peripilar white halo was reported as the most sensitive (94.12%) and specific (100%) trichoscopic finding present in both early and late stage of CCCA.…”