Case Series Highlights Features of 3 Male Patients with CCCA

Features of CCCA in Males

A new report by Lubov and colleauges highlights some of the key features of CCCA in black males. The paper is a helpful reminder that CCCA can occur in males.

PATIENT 1

The first patient in the author’s series was 41 years of age and had a 1.5 year history of hair loss along with breakage and shedding. The authors do not report whether or not he had symptoms. He wore his hair in waist-length locs in a mid-ponytail for more than 18 years. Examination of the scalp showed decreased hair density and obliteration of the follicular ostia on the vertex scalp. A punch biopsy showed a reduced number of terminal anagen follicles, with fibrosis, a lymphocytic infiltrate, and loss of sebaceous glands.

Patient 1, from Lubov et al. 2023. Patient had a had hair loss in the central portion of the scalp/ vertex region. SOURCE: Lubov et al. Central centrifugal cicatricial alopecia in Black men: A case series highlighting key clinical features in this cohort. JAAD Case Reports 2023;38:27-31. Image used with creative commons license

Trichoscopy from Patient 1 showing reduced density, peripilar gray halos. FROM: Lubov et al. Central centrifugal cicatricial alopecia in Black men: A case series highlighting key clinical features in this cohort. JAAD Case Reports 2023;38:27-31. image used with creative commons license.

PATIENT 2

The second patient was a 36 year old male with a 3 year history of hair loss affecting the vertex. He was asymptomatic. Trichoscopy showed peripilaris grey halos. A biopsy did not show loss of sebaceous glands but did show prominent perifollicular fibrosis and inflammation.

Patient 2 from paper by Lubov et al. showing scalp/vertex area at initial presentation. SOURCE: Lubov et al. Central centrifugal cicatricial alopecia in Black men: A case series highlighting key clinical features in this cohort. JAAD Case Reports 2023;38:27-31. Image used with creative commons license

PATIENT 3

The third patient in the series was a 37 year old male and had an 8 year history of itching hair loss. He had a history of high-tension hairstyles, including locs and braids. Biopsy showed perifollicular fibrosis, with loss of sebaceous glands, a lymphocytic type inflammatory infiltrate, and focal areas of premature loss of the inner root sheath.

Patient 3 from paper by Lubov et al. showing hair loss. SOURCE: Lubov et al. Central centrifugal cicatricial alopecia in Black men: A case series highlighting key clinical features in this cohort. JAAD Case Reports 2023;38:27-31. Image used with creative commons license

Histology from patient 3 showed premature desquamation of the root sheath, loss of sebaceous glands and follicular scarring and dropout. SOURCE: Lubov et al. Central centrifugal cicatricial alopecia in Black men: A case series highlighting key clinical features in this cohort. JAAD Case Reports 2023;38:27-31. Image used with creative commons license

This paper is similar to another recently published case series of 17 males with CCCA

Comment

This is a nice case series. CCCA in males may present with scalp symptoms (burning, itching, tenderness) in some but certainly not all patients. Hair grooming practices that may serve as a source of scalp injury may or may not be present on history. These include relaxers, hot combs, braids, cornrows.

Trichsocopy shows limited features sometimes although peripilar grey halos may be present. Histology does not always show loss of sebaceous glands in all CCCA but may in many. Eccentric thinning of the root sheath, premature desquamation of the inner root sheath, loss of sebaceous glands, perifollicular fibrosis and inflammation may be present.

REFERENCE

Lubov et al. Central centrifugal cicatricial alopecia in Black men: A case series highlighting key clinical features in this cohort. JAAD Case Reports 2023;38:27-31