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Clinical factors and hair care practices influencing outcomes in central centrifugal cicatricial alopecia

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Abstract

Central centrifugal cicatricial alopecia (CCCA) is the most common form of primary scarring alopecia in women of African descent, negatively impacting their quality of life. Treatment is often challenging, and we usually direct therapy to suppress and prevent the inflammation. However, factors affecting clinical outcomes are still unknown. To characterize medical features, concurrent medical conditions, hair care practices, and treatments used for patients with CCCA and assess their relationship with treatment outcomes. We analyzed data from a retrospective chart review of 100 patients diagnosed with CCCA who received treatment for at least one year. Treatment outcomes were compared with patient characteristics to determine any relationships. P-values were calculated using logistic regression and univariate analysis with 95% CI P < 0.05 was considered significant. After one year of treatment, 50% of patients were stable, 36% improved, and 14% worsened. Patients without a history of thyroid disease (P = 0.0422), using metformin for diabetes control (P = 0.0255), using hooded dryers (P = 0.0062), wearing natural hairstyles (P = 0.0103), and having no other physical signs besides cicatricial alopecia (P = 0.0228), had higher odds of improvement after treatment. Patients with scaling (P = 0.0095) or pustules (P = 0.0325) had higher odds of worsening. Patients with a history of thyroid disease (P = 0.0188), not using hooded dryers (0.0438), or not wearing natural hairstyles (P = 0.0098) had higher odds of remaining stable. Clinical characteristics, concurrent medical conditions, and hair care practices may affect clinical outcomes after treatment. With this information, providers can adjust proper therapies and evaluations for patients with Central centrifugal cicatricial alopecia.

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Data Availability

The data that support the findings of this study are available from the corresponding author, [AJM], upon reasonable request.

References

  1. Ogunleye TA, McMichael A, Olsen EA (2014) Central centrifugal cicatricial alopecia: what has been achieved, current clues for future research. Dermatol Clin 32(2):173–181

    Article  CAS  PubMed  Google Scholar 

  2. Tan Timothy et al (2019) Premature desquamation of the inner root sheath in noninflamed hair follicles as a specific marker for central centrifugal cicatricial alopecia. Am J Dermatopathol 41(5):350–354. https://doi.org/10.1097/DAD.0000000000001336

    Article  PubMed  Google Scholar 

  3. Sperling LC, Darling TN (2022) Central centrifugal cicatricial alopecia: a common but under-recognized and under-treated disease finally comes of age. J Cutan Pathol 49(2):204–206. https://doi.org/10.1111/cup.14164

    Article  PubMed  Google Scholar 

  4. Malki L, Sarig O, Romano MT et al (2019) Variant PADI3 in central centrifugal cicatricial alopecia. N Engl J Med 380(9):833–841

    Article  CAS  PubMed  Google Scholar 

  5. Shah SK, Alexis AF (2010) Central centrifugal cicatricial alopecia: retrospective chart review. J Cutan Med Surg 14(5):212–222

    Article  PubMed  Google Scholar 

  6. Coogan PF, Bethea TN, Cozier YC et al (2019) Association of type 2 diabetes with central-scalp hair loss in a large cohort study of African American women. Int J Womens Dermatol 5(4):261–266

    Article  PubMed  PubMed Central  Google Scholar 

  7. Suchonwanit P, Hector CE, Bin Saif GA, McMichael AJ (2016) Factors affecting the severity of central centrifugal cicatricial alopecia. Int J Dermatol 55(6):338–343

    Article  Google Scholar 

  8. Olsen EA, Callender V, Sperling L et al (2008) Central scalp alopecia photographic scale in African American women. Dermatol Ther 21(4):264–267

    Article  CAS  PubMed  Google Scholar 

  9. Mirmirani P, Willey A, Headington JT, Stenn K, McCalmont TH, Price VH (2005) Primary cicatricial alopecia: histopathologic findings do not distinguish clinical variants. J Am Acad Dermatol 52(4):637–643

    Article  PubMed  Google Scholar 

  10. Felix K, De Souza B, Portilla N et al (2020) Dermatoscopic evaluation of central centrifugal cicatricial alopecia beyond the vertex scalp. JAMA Dermatol 156(8):916–918

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lawson CN, Bakayoko A, Callender VD (2021) Central centrifugal cicatricial alopecia: challenges and treatments. Dermatol Clin 39(3):389–405

    Article  CAS  PubMed  Google Scholar 

  12. Kyei A, Bergfeld WF, Piliang M, Summers P (2011) Medical and environmental risk factors for the development of central centrifugal cicatricial alopecia: a population study. Arch Dermatol 147(8):909–914

    Article  PubMed  Google Scholar 

  13. Olsen EA, Callender V, McMichael A et al (2011) Central hair loss in African American women: incidence and potential risk factors. J Am Acad Dermatol 64(2):245–252

    Article  PubMed  Google Scholar 

  14. Narasimman M, De Bedout V, Castillo DE, Miteva MI (2020) Increased association between previous pregnancies and use of chemical relaxers in 74 women with central centrifugal cicatricial alopecia. Int J Trichol 12(4):176–181

    Article  Google Scholar 

  15. Araoye EF, Thomas JAL, Aguh CU (2020) Hair regrowth in 2 patients with recalcitrant central centrifugal cicatricial alopecia after use of topical metformin. JAAD Case Rep 6(2):106–108

    Article  PubMed  PubMed Central  Google Scholar 

  16. Aguh C, Dina Y, Talbot CC Jr, Garza L (2018) Fibroproliferative genes are preferentially expressed in central centrifugal cicatricial alopecia. J Am Acad Dermatol 79(5):904–912

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Uhlenhake EE, Mehregan DM (2013) Prospective histologic examinations in patients who practice traumatic hairstyling. Int J Dermatol 52(12):1506–1512

    Article  PubMed  Google Scholar 

  18. Gathers RC, Jankowski M, Eide M, Lim HW (2009) Hair grooming practices and central centrifugal cicatricial alopecia. J Am Acad Dermatol 60:574–578

    Article  PubMed  Google Scholar 

  19. Dlova NC, Salkey KS, Callender VD, McMichael AJ (2017) Central centrifugal cicatricial alopecia: new insights and a call for action. J Investig Dermatol Symp Proc 18(2):S54–S56

    Article  PubMed  Google Scholar 

  20. Summers P, Kyei A, Bergfeld W (2011) Central centrifugal cicatricial alopecia—an approach to diagnosis and management. Int J Dermatol 50(12):1457–1464

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Antoine Prayer, a medical student, for his contribution to gathering the data for the study.

Funding

This study was supported by a research Grant from Vanderbilt University School of Medicine.

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Authors and Affiliations

  1. Nashville, USA

    Toluwalashe Onamusi

  2. Department of Dermatology, Wake Forest School of Medicine, 4618 Country Club Rd, Winston Salem, NC, 27104, USA

    Jorge Larrondo & Amy J. McMichael

  3. Department of Dermatology, Clinica Alemana-Universided del Desarrollo, Santiago, Chile

    Jorge Larrondo

  4. Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA

    Toluwalashe Onamusi

Authors
  1. Toluwalashe Onamusi
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  2. Jorge Larrondo
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  3. Amy J. McMichael
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Contributions

Vanderbilt University School of Medicine had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Corresponding author

Correspondence to Amy J. McMichael.

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Conflict of interest

Conflict of Interest Disclosures. Dr McMichael reported being a consultant for Almirall, Arcutis, Concert, Revian, UCB, Lilly, Pfizer, Galderma, Incyte, and Procter & Gamble; reported performing research for Incyte and Procter & Gamble; reported receiving grants from Procter & Gamble, Concert, and Incyte; and reported receiving personal fees from UpToDate outside the submitted work. No other disclosures were reported.

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Onamusi, T., Larrondo, J. & McMichael, A.J. Clinical factors and hair care practices influencing outcomes in central centrifugal cicatricial alopecia. Arch Dermatol Res 315, 2375–2381 (2023). https://doi.org/10.1007/s00403-023-02630-5

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  • DOI: https://doi.org/10.1007/s00403-023-02630-5

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