Medical and Environmental Risk Factors for the Development of Central Centrifugal Cicatricial Alopecia

Abstract

To investigate medical and environmental risk factors for central centrifugal cicatricial alopecia (CCCA), the most common type of scarring alopecia in African American women.Design: A population study involving a quantitative cross-sectional survey of risk factors for CCCA. Survey results are then correlated with a clinical evaluation for CCCA using a standardized, previously published central scalp alopecia photographic scale.Setting: Two African American churches and a health fair for African American women in Cleveland, Ohio.Participants: A total of 326 African American women who participated in the hair study.Main Outcome Measures: Prevalence of CCCA in the general African American population and risk factors associated with CCCA.Results: Of the 326 responders, 28% received a grade of 2 or higher using a standardized, previously pub-lished central scalp alopecia photographic scale, a score consistent with clinically evident central hair loss. Advanced central hair loss with clinical signs of scarring (grade Ն3) was seen in 59% of these respondents and was interpreted as clinically consistent with CCCA. Diabetes mellitus type 2 was significantly higher in those with CCCA (P=.01), as were bacterial scalp infections (P=.045) and hair styles associated with traction (eg, from braids and weaves) (P =.02). Conclusions:Our survey results suggest that there is a high prevalence of central hair loss among African American women. Hair styles causing traction as well as inflammation in the form of bacterial infection may be contributing to the development of CCCA. The increase in diabetes mellitus type 2 among those with CCCA is in line with the recent theory that cicatricial alopecia may be a manifestation of metabolic dysregulation.

Hair and scalp disorders in women of African descent: an overview

“…In both of the South African studies, histopathological assessment was not undertaken, thus subjects were diagnosed based on clinical assessment only. The two North American studies 30,31 evaluated the prevalence of hair loss in African-American women. The first 30 involved 529 participants from six study sites including a hair and beauty symposium, two church groups and three standalone workshops.…”

“…The symposium and church groups had a 5Á6% point prevalence of CCCA, but at the three stand-alone workshops this was 16%, demonstrating how sampling techniques can impact results. The second study, 31 including 326 subjects from two churches and a health fair, reported a prevalence of CCCA of 17%. The two North American studies used a validated photographic scale to diagnose CCCA, but again the findings were not supported by histopathological assessment.…”

“…Finally, there are limited data linking CCCA with type 2 diabetes mellitus. 31 This is especially pertinent given the emerging role of peroxisome proliferator-activator receptor (PPAR)-c in the aetiopathogenesis of scarring alopecias such as LPP. 72,73 Clinically, CCCA presents as a slow-growing area of alopecia involving the crown and/or vertex scalp regions 3,74 (Figs 4b and 7).…”

Is prediabetes risk factor for hair loss?

“…First of all, the community based study, a significant association has been found between androgenetic alopecia and the presence of metabolic syndrome (odds ratio-OR 1.67) and also metabolic syndrome components (OR 1.21) after controlling for age, family history of AGA and smoking status [6]. In the populaton based study investigating risk factors for central hair loss, presence of diabetes mellitus type 2 was found significantly higher among the other environmental and medical factors in patients with central hair loss [7]. In recent case control study patients with androgenetic alopecia had significantly higher hyperglycemia (>110 mg/dL) ratio (39.1%) than controls (12.5%) [8].…”

The Association between Metabolic Syndrome Components and Hair Loss both Male and Female Individuals

“…Author concluded that [16]. In the population based study investigating risk factors for central hair loss, presence of diabetes mellitus type 2 was significantly higher among the other environmental and medical factors in patients with central hair loss in African women [17].…”