During her session, “What's New in Traction Alopecia, Alopecia Areata and CCCA,” presented at the 2023 AAD Annual Meeting, Victoria Holloway Barbosa, MD, FAAD, reviewed treatments and best practices when managing Black hair.

Starting with traction alopecia, she reviewed that this is hair loss due to prolonged or recurrent tension on the hair that is initially nonscarring but may scar over time. It’s most commonly seen in women of African descent, but she stressed it can also be seen in other populations as well.

Typically, traction alopecia is present at the front hairline, but can sometimes be presented at the occiput. Normally, it appears as a fringe sign, which are the baby hairs that do not quite make it into the cornrow or the individual braid.

“Just bear in mind that it's not always the front hairline. Not everything at the front hairline is traction alopecia in a woman,” she stated. She also shared that pattern alopecia areata often gets misdiagnosed as traction alopecia.

For treatment, Dr Barbosa went over intralesional steroids and high potency topical steroids. She also shared that topical minoxidil is another option. She noted that she only uses oral antibiotics if folliculitis is present and if the patient can undergo transplantation if they do not achieve the results that they want, such as if there has been too much scarring.

She also shared that frequent braiding with additional hair not only can contribute to traction alopecia, but also contributes to damage to the hair fiber. It is important to point out that individuals should rotate their hairstyles because this can also lead to breakage along the hair shaft from the alopecia.

Next, Dr Barbosa shifted to alopecia areata by introducing trichoscopy, which can help differentiate forms of alopecia if the physician is unable to tell. She noted that physicians should look for exclamation point hairs, broken hairs, yellow dots, and a follicular ostium, which are typical characteristic of alopecia areata. She also stressed that, when in doubt, a biopsy should be performed particularly at the front hairline.

When treating alopecia areata, Dr Barbosa shared that there are topical and intralesional therapies available (such as platelet-rich plasma, triamcinolone, and more) in addition to systemic treatments (for example, prednisone, cyclosporine, etc.). However, there are some new options on the horizon, such as:

• Topical Janus kinase (JAK) Inhibitors: ruxolitinib and tofacitinib
• Oral JAK inhibitors: baricitinib (now US Food and Drug Administration approved), ritlecitinib, ruxolitinib, and tofacitinib
• Eximer laser or He-Ne laser combined with minoxidil
• Fractional laser with or without oral minoxidil or cortisol
• Topical methotrexate 1% gel

Dr Barbosa then transitioned into central centrifugal cicatricial alopecia (CCCA), sharing how it is often presented as hair loss or breakage at the crown with itching that could be with or without a family history or pruritus. This has several years of duration, with the differential being lichen planopilaris and lupus.

For treatment, she shared that the first management goal is to use topical and/or intralesional steroids, or orals such as doxycycline, minocycline, and hydroxychloroquine. The second management goal is to encourage growth by using products such as topical or oral minoxidil, finasteride, and supplements.

At the conclusion of her session, Dr Barbosa shared that there were still many unanswered questions on the etiology and role of hair care surrounding CCCA.

“It’s important to not give up on these patients because a lot of them do have regrowth and screen for other medical conditions,” she closed.

Reference
Barbosa VH. What's new in traction alopecia, alopecia areata and CCCA. Presented at: AAD Annual Meeting; March 17–21, 2023; New Orleans, LA.