CCCA

Can it occur in children?

Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia which affects the center of the scalp in black women. It typically occurs in women between the ages of 35-50 and is thought to be rather rare in younger ages. The cause is not known but genetics and trauma to the scalp (ie. from chemical relaxers) may be relevant.

Amy McMichael and colleagues presented a study of six adolescents with biopsy proven CCCA. Of the six patients with CCCA, 5 reported that they wore their hair natural. A family history of CCCA was present in the majority of patients.

This is an unusual and unexpected study. We typically think of CCCA as a condition that occurs in middle age women, but this data opens the possibility that it may, in fact, occur in younger age groups. I still remain skeptical, and for several reasons:

1) CCCA is a very broad term and encompasses many conditions. ‘CCCA’ occurring in teenagers with no history of chemical processing of the scalp is probably different than ‘CCCA’ occurring in middle aged adults.

2) I think we have limited understanding of the histology of the normal scalp. It would be interesting to have histological information on teenagers without hair loss. My experience is that many would have changes that would be compatible with CCCA even though such children have no hair loss. We have a long way to go in fully understanding CCCA.

We certainly need to be open to the possibility of putting forth a diagnosis of ‘CCCA” in adolescents with hair loss whose histology resembles classical adult CCCA. This study suggests that if CCCA truly is a phenomenon on teenagers, it may have a strong genetic basis and not be driven by traumatic hair care experiences.

Reference
Eginli et al. Central centrifugal Cicatricial alopecia in Children. A Case series and review of the literature. Pediatric Dermatology 2016;