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CCCA — SCE Dermatology MCQ

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ModerateHair DisordersCCCASCE Dermatology

A 35-year-old woman has central centrifugal cicatricial alopecia (CCCA). She has progressive scarring hair loss starting from the crown and expanding centrifugally. She uses chemical hair relaxers. Biopsy shows premature desquamation of the inner root sheath with perifollicular fibrosis. What is the most important initial intervention?

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Correct answer: A — Discontinue chemical hair treatments (relaxers, hot combs) and start anti-inflammatory therapy

CCCA is the most common cause of scarring alopecia in women of African descent. It presents with progressive vertex-centred hair loss expanding outward. Chemical hair treatments (alkaline relaxers, hot combing, tight braiding) contribute to follicular damage. The premature desquamation of the inner root sheath (PDIRS) on biopsy is a characteristic histological finding. Management involves: (1) discontinuation of chemical/thermal hair processing; (2) anti-inflammatory therapy with potent topical/intralesional corticosteroids; (3) oral Doxycycline or Hydroxychloroquine for anti-inflammatory effect; (4) topical Minoxidil to support remaining follicles. PADI3 gene mutations have been identified as a genetic predisposition.

Reference: BAD 2012 Cicatricial Alopecia; AAD 2019 CCCA