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

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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.


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


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

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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.

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Correspondence to Amy J. McMichael.

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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).

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