Loren Krueger, MD, FAAD, kicked off her session, “Central Centrifugal Cicatricial Alopecia (CCCA): Advances in Diagnosis and Treatment,” at the 2023 AAD Annual Meeting with the history and timeline of CCCA.

Dr Krueger started with the background of the disease and mentioned that the goal of treating scarring alopecia is to halt progression and achieve limited regrowth, “We can potentially get [patients] back to 10% to 20% repair. [Scarring alopecia] can be associated with itching, burning, and tiredness. Itch is not histamine-induced but is cowhage-induced.” She also reviewed the clinical findings and presentations in CCCA, including trichoscopy.

Next, Dr Krueger, with the help of various studies, discussed the role of genetics and correlation with fibroproliferative disorders, “We’re not exactly sure what triggers CCCA, but we do know there is a genetic predisposition to fibrosis and there is an environmental trigger.”

She then moved on to describe the associations with uterine leiomyomas and diabetes mellitus (DM), “There are 4 times increased odds of DM2 in nonobese women with CCCA.”

Dr Kruger talked about the treatment considerations, “When I approach a treatment, there are a couple of things which I consider and look at holistically.” These include progression (How quickly is [the disease] progressing and how severe is it?) and signs and symptoms of the activity (hair breakage or bogginess at the crown, scaling, or pustules).

“It is also important to note that CCCA can have no symptoms,” she added.

Finally, Dr Krueger discussed her treatment approaches. How does she treat the above symptoms (or disease with no symptoms)? 

• Topical treatments (“TCM protocol”): calcineurin inhibitors, glucocorticoids, and minoxidil
• Intralesional triamcinolone
• Oral treatments: doxycycline, hydroxychloroquine, mycophenolate mofetil, etc.
• Topical metformin
• Platelet-rich plasma
• Treatment algorithm: maintenance phase
• Treatment algorithm: regrowth phase

Dr Krueger concluded the session by answering the question on “How do I style my hair?” Based on a study that concluded there is no association between extensive central hair loss and hot combing or relaxers, she concluded that “we should not be guilting our patients or make them feel guilty about using heating products as we do not have strong evidence that suggests there’s a link between the 2.” 

Reference
Krueger L. CCCA: advances in diagnosis and treatment. Presented at: AAD Annual Meeting; March 17–21, 2023; New Orleans, LA.