Dermatoscopic Evaluation of Central Centrifugal Cicatricial Alopecia Beyond the Vertex Scalp

Abstract

Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia commonly seen in African American individuals. 1 It classically affects the vertex scalp, although 1 study 2 suggests that it may manifest as patchy hair loss beyond the vertex. In that study, the histopathologic, dermatoscopic, and clinical findings were crucial in diagnosis. However, another study 3 reported histopathologic changes in the vertex scalp consistent with CCCA even without clinically visible hair loss. Our study explored dermatoscopic and histopathologic findings in areas of the scalp without clinically active disease, specifically beyond the vertex scalp. We also assessed the reliability of dermatoscopy, which may serve as a less invasive diagnostic tool than biopsy, for the diagnosis of CCCA in the context of subclinical disease.

Seborrheic Dermatitis as a Potential Trigger of Central Centrifugal Cicatricial Alopecia: A Review of Literature

“…In addition, like SD, CCCA is associated with scaling. Follicular scales were found to be a classic dermoscopic finding in majority of the CCCA patients (68%) in a cross-sectional study [26], while SD is associated with interfollicular and perifollicular scales [27]. There have also been several case reports of patients with long-standing scalp psoriasis, another inflammatory and pruritic papulosquamous dermatosis of the scalp, that progressed to cicatricial alopecia [28].…”

Gene expression profiling suggests severe, extensive central centrifugal cicatricial alopecia may be both clinically and biologically distinct from limited disease subtypes

“…In the authors' experience, clinical progression of hair loss is often variable, as some patients experience rapid progression to end‐stage disease within a few years of disease onset while others may experience slow, gradual progression over decades and may never approach end‐stage or extensive involvement. Though a recent study found that clinically unaffected areas of the scalp in CCCA patients have histologic evidence of active disease, 6 variation in disease course, particularly in the rate of disease progression, is unexplained by this discovery and instead suggests multiple CCCA disease phenotypes. We therefore sought to characterize the expression pattern in a small subset of CCCA patients with accelerated progression to clinically severe, extensive disease involvement.…”