CCCA is a categorized as a primary Cicatricial Alopecia (Scarring Alopecia). CCCA occurs typically in women of African ancestry. Hair breakage or traction alopecia may also be present in a patient with CCCA, and if present, that needs to be addressed separately.

Genetic predisposition is likely a factor in CCCA, but the exact cause is unknown at present. Patients may have female relatives with similar hair loss and CCCA is the only scarring (cicatricial) alopecia in which family members (usually female relatives) may have a similar problem. It has been diagnosed in African men also, but only in a very small percentage.

The unique grooming and hair styling practices of women with African ancestry is believed to play a role in causing CCCA. Traction (braids and weaves) and heat (hot combs) and chemical relaxers (formaldehyde in Brazilian relaxers) are suspected agents in causing the problem. Other factors include Diabetes as a risk factor and some women may also give a history of increased facial hair, adult acne, irregular menstruation and difficulty getting pregnant (infertility). It is mostly seen in middle aged women.

It is postulated that follicular stem cells may be repeatedly injured by chemical, physical or thermal trauma over many years. On the other hand, many women of African Ethnicity who have used the same styling practices for many years don’t develop CCCA and other women who have never used chemical relaxers, hot combs or made use of weaves and braids develop CCCA. This suggests that hair care practices alone are not the primary cause of CCCA and it points to a combination of environmental and genetic factors. If hair breakage is present, a history of hair care practices is essential. If traction alopecia is present, there will be thinning and receding of the frontal hairline and temporal areas.

The hair loss from CCCA is permanent, but otherwise the condition has no systemic effects on the body. A scalp biopsy is required to confirm the diagnosis and to establish if the condition is active or not. Some patients may say that their hair has stopped growing and this is a consequence of the hair shafts becoming very fragile and breaking easily.

Stopping hair styling and grooming practices has a positive effect on hair breakage and traction alopecia but has no effect with CCCA.

Sources:
– Cicatricial Alopecia, An Approach to Diagnosis and Managent, by V Price and P Mirmirani
– Disorders of Hair Growth, Diagnosis and Treatment, by Elise A Olsen
– Discussions with colleagues, Dr. J Donovan from Toronto, during 2015 ISHRS Conference in Chicago, September 2015.

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