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Gadre A, Dyson T, Jedrych J, Anhalt G, Byrd AS, Aguh C. Proteomic Profiling of Central Centrifugal Cicatricial Alopecia Reveals Role of Humoral Immune Response Pathway and Metabolic Dysregulation. JID INNOVATIONS 2024; 4:100263. [PMID: 38585195 PMCID: PMC10995914 DOI: 10.1016/j.xjidi.2024.100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 04/09/2024] Open
Abstract
Proteomic profiling on other primary cicatricial alopecias, such as frontal fibrosing alopecia and lichen planopilaris, have suggested a T helper 1-mediated inflammatory pathway, but in central centrifugal cicatricial alopecia (CCCA), the protein expression patterns are unknown. In this study, we sought to characterize protein expression patterns in CCCA to identify biomarkers of disease activity that will identify potential therapeutic avenues for treatment. Scalp protein quantification was performed to understand protein expression patterns in affected versus unaffected scalps in CCCA. A total of 5444 proteins were identified, of which 148 proteins were found to be differentially expressed in CCCA-affected scalp, with upregulation of adaptive immune pathways (IGHG3, P = .034; IGHG4, P = .01; IGG1, P = .026) and markers of fibrosis (ITGA1, P = .016; SFRP2, P = .045; TPM2, P = .029; SLMAP, P = .016) and downregulation of metabolic proteins (ALOX15B, P = .003; FADS2, P = .006; ELOVL5, P = .007; FA2H, P = .017; FAR2, P = .011; SC5D, P < .001). Our analysis revealed, to our knowledge, previously unknown humoral immune canonical pathways, notably IgG, implicated in CCCA and additionally confirmed aberrant lipid metabolism pathways implicated in diabetes mellitus, suggesting unique mechanisms of disease in patients with CCCA.
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Affiliation(s)
- Aditi Gadre
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Taylor Dyson
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Jaroslaw Jedrych
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Grant Anhalt
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Angel S. Byrd
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Dermatology, College of Medicine, Howard University, Washington, District of Columbia, USA
| | - Crystal Aguh
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Geisler AN, Taye M, Larrondo J, Mayo TT, Aguh C, McMichael A, MacKelfresh JB, Krueger L. Updates on disorders in curly hair. Int J Dermatol 2024. [PMID: 38622785 DOI: 10.1111/ijd.17184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/17/2024]
Abstract
Hair disorders, including central centrifugal cicatricial alopecia (CCCA), traction alopecia (TA), and acquired trichorrhexis nodosa (ATN), commonly occur in individuals with curly textured hair. Curly textured hair in individuals of African descent has unique properties and can present diagnostic and therapeutic challenges. CCCA has been linked to uterine leiomyoma and type 2 diabetes mellitus, as well as fibroproliferation. TA often presents with a fringe sign and can arise from high-tension hairstyles presumed to be protective. Trichoscopy is useful in establishing a diagnosis; perifollicular halos are more commonly seen than perifollicular erythema or scale in CCCA. In TA, miniaturized follicles, hair casts, and "flambeau sign" can be seen. Hairstyling practices likely contribute to TA and ATN; however, the data are mixed on the role of chemical relaxers and heat styling in CCCA. Unique considerations in the presentation of frontal fibrosing alopecia in curly textured hair have also been published recently. This review provides a comprehensive, up-to-date summary of these disorders with an emphasis on their unique properties, as well as considerations in hair care for curly textured hair.
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Affiliation(s)
- Amaris N Geisler
- Department of Dermatology, Emory University School of Medicine, Atlanta, USA
| | - Marta Taye
- Department of Dermatology, Emory University School of Medicine, Atlanta, USA
| | - Jorge Larrondo
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Tiffany T Mayo
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, USA
| | - Crystal Aguh
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, USA
| | - Amy McMichael
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Jamie B MacKelfresh
- Department of Dermatology, Emory University School of Medicine, Atlanta, USA
| | - Loren Krueger
- Department of Dermatology, Emory University School of Medicine, Atlanta, USA
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3
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Elston DM, Elewski BE, Taylor S. Letter from the editor: Making sense of central centrifugal cicatricial alopecia. J Am Acad Dermatol 2024:S0190-9622(24)00584-X. [PMID: 38604488 DOI: 10.1016/j.jaad.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Dirk M Elston
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina.
| | - Boni E Elewski
- Department of Dermatology, University of Alabama, Birmingham, Alabama
| | - Susan Taylor
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
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4
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Sow YN, Jackson TK, Taylor SC, Ogunleye TA. Lessons from a scoping review: Clinical presentations of central centrifugal cicatricial alopecia. J Am Acad Dermatol 2024:S0190-9622(24)00498-5. [PMID: 38521463 DOI: 10.1016/j.jaad.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 02/10/2024] [Accepted: 03/05/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Central centrifugal cicatricial alopecia (CCCA) nomenclature describes a typical clinical presentation of cicatricial hair loss that begins on the vertex scalp with progressive, symmetric, and centrifugal evolution. However, atypical presentations have been noted clinically by the authors and reported in the literature. OBJECTIVE We sought to characterize the distribution of hair loss in published cases of adult patients with CCCA. METHODS A 3-step search process was used to evaluate research articles in Cumulative Index to Nursing & Allied Health, EMBASE, Google Scholar, MEDLINE, Scopus, and Web of Science databases. Studies with scalp photography or description of hair loss distribution were included. Three researchers evaluated eligible studies for clinical subtypes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review was used to report results. RESULTS Ninety-nine studies consisting of 281 cases of CCCA were included. Hair loss distributions included variants of the classic presentation along with distinct subtypes such as patchy, occipital, parietal, frontal, temporal, and trichorrhexis. LIMITATIONS Studies had significant homogeneity, as the classic distribution of CCCA was commonly reported. Additionally, clinically diagnosed cases may have concurrent diagnoses, and numerous studies did not report trichoscopy findings. CONCLUSION CCCA terminology may not always be reflective of clinical presentation. Understanding atypical presentations is essential to inform appropriate and targeted treatment.
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Affiliation(s)
| | | | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Temitayo A Ogunleye
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Fatima SZ. Central centrifugal cicatricial alopecia: a deeper insight into the disease. Wien Med Wochenschr 2024:10.1007/s10354-024-01033-z. [PMID: 38383911 DOI: 10.1007/s10354-024-01033-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/15/2024] [Indexed: 02/23/2024]
Abstract
Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia of multifactorial etiology that presents on the vertex as patchy areas of hair loss, spreading centrifugally over the scalp. It most commonly affects women of African descent, but cases among other ethnicities have also been reported. CCCA typically starts with thinning and breaking of the hair as the first sign of presentation, which eventually progresses to hair loss over the central part of the scalp, spreading symmetrically outwards to involve a larger area. Currently, there is no definitive cure for the disease; however, multiple management options are available, which should aim to be tailored to the individual patient. Owing to its cosmetic outcomes, the quality of life (QoL) of patients with central centrifugal cicatricial alopecia is also disturbed, as patients may face psychological and social stress due to their permanent hair loss. This article focuses on various aspects of the pathogenesis, clinical trials, quality of life, barriers faced by patients, and treatment of central centrifugal cicatricial alopecia.
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Affiliation(s)
- Syeda Zainab Fatima
- Dow University of Health Sciences, Baba-E-Urdu Road, 74200, Karachi, Pakistan.
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Jackson T, Sow Y, Dinkins J, Aguh C, Omueti Ayoade K, Barbosa V, Burgess C, Callender V, Cotsarelis G, Grimes P, Harvey V, Kindred C, Lester J, Lo Sicco K, Mayo T, McMichael A, Oboite M, Ogunleye T, Olsen E, Osei-Tutu A, Piliang M, Senna M, Shapiro J, Tosti A, Frey C, Adotama P, Taylor SC. Treatment for central centrifugal cicatricial alopecia-Delphi consensus recommendations. J Am Acad Dermatol 2024:S0190-9622(24)00308-6. [PMID: 38341148 DOI: 10.1016/j.jaad.2023.12.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/30/2023] [Accepted: 12/23/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND There is no established standard of care for treating central centrifugal cicatricial alopecia (CCCA), and treatment approaches vary widely. OBJECTIVE To develop consensus statements regarding the use of various pharmacological therapies in treating adults with CCCA. METHODS We invited 27 dermatologists with expertise in hair and scalp disorders to participate in a 3-round modified Delphi study between January and March 2023. Statements met strong consensus if 75% of respondents agreed or disagreed. Statements met moderate consensus if 55% or more but less than 75% agreed or disagreed. RESULTS In round 1, 5 of 33 (15.2%) statements met strong consensus, followed by 9 of 28 (32.1%) in round 2. After the final round 3 meeting, strong consensus was reached for 20 of 70 (28.6%) overall statements. Two statements achieved moderate consensus. LIMITATIONS This study included only English-speaking, US-based dermatologists and did not consider nonpharmacological therapies. CONCLUSION Despite varying opinions among dermatologists, consensus was reached for several statements to help clinicians manage CCCA. We also highlight areas that lack expert consensus with the goal of advancing research and therapeutic options for CCCA.
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Affiliation(s)
| | - Yacine Sow
- Morehouse School of Medicine, Atlanta, Georgia
| | | | - Crystal Aguh
- Department of Dermatology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Katherine Omueti Ayoade
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Victoria Barbosa
- Section of Dermatology, University of Chicago Medicine, Chicago, Illinois
| | - Cheryl Burgess
- Center for Dermatology and Dermatologic Surgery, Washington, District of Columbia
| | | | - George Cotsarelis
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pearl Grimes
- Grimes Center for Medical and Aesthetic Dermatology, Vitiligo and Pigmentation Institute of Southern California, Los Angeles, California
| | - Valerie Harvey
- Tidewater Physicians Multispecialty Group, Virginia Beach, Virginia; Hampton Roads Center for Dermatology, Newport News, Virginia
| | | | - Jenna Lester
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York
| | - Tiffany Mayo
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Amy McMichael
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Michelle Oboite
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Temitayo Ogunleye
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elise Olsen
- Department of Dermatology, Duke University, Durham, North Carolina
| | | | - Melissa Piliang
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Maryanne Senna
- Lahey Hair Loss Center of Excellence and Research Unit, Burlington, Massachusetts
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York
| | - Antonella Tosti
- Department of Dermatology, University of Miami, Miami, Florida
| | - Cheri Frey
- Department of Dermatology, Howard University, Washington, District of Columbia
| | - Prince Adotama
- The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Jackson TK, Sow Y, Ayoade KO, Seykora JT, Taylor SC, Ogunleye T. Central centrifugal cicatricial alopecia in males. J Am Acad Dermatol 2023; 89:1136-1140. [PMID: 37495175 DOI: 10.1016/j.jaad.2023.07.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/13/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia seen primarily in women of African descent but rarely reported in men. The etiology of CCCA is unknown, but genetic variants, type 2 diabetes mellitus, and bacterial infections may play a role. OBJECTIVES We aimed to characterize the demographics, medical histories, and clinical findings of male patients with CCCA with the hypothesis that features may differ from women. METHODS This was a case series of adult male patients with biopsy-confirmed CCCA seen at an academic dermatology department between 2012 and 2022. RESULTS In total, 17 males had a scalp biopsy and clinical findings consistent with CCCA. The average age was 43 years, and 88.2% of cases identified as Black race. Scalp pruritus was the most common symptom, and few patients endorsed high-risk hair care practices. None of the cases had diagnosis of type 2 diabetes mellitus, but 17.6% had history of latent tuberculosis, and 47.1% had a positive family history of alopecia. We observed 8 patients with atypical CCCA, and 29.4% had an overlapping scalp diagnosis. LIMITATIONS This study is limited by the single center, retrospective design and small sample size. CONCLUSIONS It is important to consider CCCA in the differential diagnosis of alopecia in adult Black males.
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Affiliation(s)
| | - Yacine Sow
- Morehouse School of Medicine, Atlanta, Georgia
| | - Katherine Omueti Ayoade
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John T Seykora
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Cell and Molecular Biology Graduate Group, Cutaneous Phenomics and Transcriptomics Core, Penn Skin Biology and Diseases Resource-based Center, Philadelphia, Pennsylvania
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Temitayo Ogunleye
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Aboalola D, Aouabdi S, Ramadan M, Alghamdi T, Alsolami M, Malibari D, Alsiary R. An Update on Alopecia and its Association With Thyroid Autoimmune Diseases. TOUCHREVIEWS IN ENDOCRINOLOGY 2023; 19:54-59. [PMID: 38187080 PMCID: PMC10769472 DOI: 10.17925/ee.2023.19.2.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/30/2023] [Indexed: 01/09/2024]
Abstract
Alopecia is comorbid with several illnesses, including various autoimmune conditions such as thyroid disease. Leukocyte-mediated inflammation of hair follicles in alopecia was first described over a century ago. However, the high prevalence of the role of thyroid autoimmune disease in the pathogenesis of alopecia has only recently come to light, together with a strong association between the two. Therefore, this review focuses on articles published between 2011 and 2022 on alopecia's association with thyroid autoimmune disease, and the mechanism behind it. In addition, it highlights the link between alopecia and thyroid cancer, as patients with alopecia have increased risk of thyroid cancer. In conclusion, this comprehensive, focused, scoping review will serve as a reference highlighting recent information on alopecia, exploring its association with thyroid autoimmune diseases.
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Affiliation(s)
- Doaa Aboalola
- King Abdullah International Medical Research Center, Jeddah, Western Region, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Western Region, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Western Region, Saudi Arabia
| | - Sihem Aouabdi
- King Abdullah International Medical Research Center, Jeddah, Western Region, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Western Region, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Western Region, Saudi Arabia
| | - Majed Ramadan
- King Abdullah International Medical Research Center, Jeddah, Western Region, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Western Region, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Western Region, Saudi Arabia
| | - Tariq Alghamdi
- King Abdullah International Medical Research Center, Jeddah, Western Region, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Western Region, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Western Region, Saudi Arabia
| | - Mona Alsolami
- King Abdullah International Medical Research Center, Jeddah, Western Region, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Western Region, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Western Region, Saudi Arabia
| | - Dalal Malibari
- King Abdullah International Medical Research Center, Jeddah, Western Region, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Western Region, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Western Region, Saudi Arabia
| | - Rawiah Alsiary
- King Abdullah International Medical Research Center, Jeddah, Western Region, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Western Region, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Western Region, Saudi Arabia
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9
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Onamusi T, Larrondo J, McMichael AJ. Clinical factors and hair care practices influencing outcomes in central centrifugal cicatricial alopecia. Arch Dermatol Res 2023; 315:2375-2381. [PMID: 37188887 DOI: 10.1007/s00403-023-02630-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
Central centrifugal cicatricial alopecia (CCCA) is the most common form of primary scarring alopecia in women of African descent, negatively impacting their quality of life. Treatment is often challenging, and we usually direct therapy to suppress and prevent the inflammation. However, factors affecting clinical outcomes are still unknown. To characterize medical features, concurrent medical conditions, hair care practices, and treatments used for patients with CCCA and assess their relationship with treatment outcomes. We analyzed data from a retrospective chart review of 100 patients diagnosed with CCCA who received treatment for at least one year. Treatment outcomes were compared with patient characteristics to determine any relationships. P-values were calculated using logistic regression and univariate analysis with 95% CI P < 0.05 was considered significant. After one year of treatment, 50% of patients were stable, 36% improved, and 14% worsened. Patients without a history of thyroid disease (P = 0.0422), using metformin for diabetes control (P = 0.0255), using hooded dryers (P = 0.0062), wearing natural hairstyles (P = 0.0103), and having no other physical signs besides cicatricial alopecia (P = 0.0228), had higher odds of improvement after treatment. Patients with scaling (P = 0.0095) or pustules (P = 0.0325) had higher odds of worsening. Patients with a history of thyroid disease (P = 0.0188), not using hooded dryers (0.0438), or not wearing natural hairstyles (P = 0.0098) had higher odds of remaining stable. Clinical characteristics, concurrent medical conditions, and hair care practices may affect clinical outcomes after treatment. With this information, providers can adjust proper therapies and evaluations for patients with Central centrifugal cicatricial alopecia.
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Affiliation(s)
- Toluwalashe Onamusi
- , Nashville, USA
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
| | - Jorge Larrondo
- Department of Dermatology, Wake Forest School of Medicine, 4618 Country Club Rd, Winston Salem, NC, 27104, USA
- Department of Dermatology, Clinica Alemana-Universided del Desarrollo, Santiago, Chile
| | - Amy J McMichael
- Department of Dermatology, Wake Forest School of Medicine, 4618 Country Club Rd, Winston Salem, NC, 27104, USA.
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Larrondo J, McMichael AJ. Scarring Alopecia. Dermatol Clin 2023; 41:519-537. [PMID: 37236719 DOI: 10.1016/j.det.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
African hair shaft and pigmented scalp have unique features that challenge diagnosis in scarring alopecia. In addition, Black patients may associate 2 or more types of hair disorders. Therefore, it is imperative to understand their findings thoroughly to establish a good diagnosis. Differential diagnosis on the frontal scalp includes traction alopecia and frontal fibrosing alopecia. Disorders such as central centrifugal cicatricial alopecia, fibrosing alopecia in a pattern distribution, discoid lupus erythematosus, and lichen planopilaris usually affect the middle scalp. Folliculitis decalvans, dissecting cellulitis, and acne keloidalis nuchae are the main differential diagnosis of the posterior scalp.
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Affiliation(s)
- Jorge Larrondo
- Department of Dermatology, Wake Forest Baptist Health, 4618 Country Club Road, Winston-Salem, NC 27104, USA; Department of Dermatology, Clínica Alemana-Universidad del Desarrollo, Av. Vitacura 5951, Santiago, 7650568, Chile
| | - Amy J McMichael
- Department of Dermatology, Wake Forest Baptist Health, 4618 Country Club Road, Winston-Salem, NC 27104, USA.
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Ho JD, Collie CJ, Spencer SA. Histopathologic Spectrum of Alopecias Seen in a Jamaican Setting. Am J Dermatopathol 2023; Publish Ahead of Print:00000372-990000000-00207. [PMID: 37377278 DOI: 10.1097/dad.0000000000002487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
ABSTRACT Alopecia is common in Jamaican, primarily Afro-Caribbean patients. We performed a retrospective review examining the histopathologic alopecia diagnoses over ∼5 years. Requisition forms and pathology reports were assessed. Demographic/clinical/technical/diagnostic and pathologic findings of chronicity/severity data were recorded. Three hundred thirty-eight biopsies were included. The majority were 4 mm punches, grossed horizontally. The F:M ratio was 4.8:1, mean age = 42.7 years, and mean duration of alopecia = 5.1 years. Cicatricial alopecias (CAs) predominated over non-CAs (NCAs). The top 10 diagnoses were central centrifugal CA (21.9%), folliculitis decalvans (10.9%), multifactorial alopecias (10.1%), pattern hair loss (8%), lichen planopilaris (7.1%), alopecia areata (6.2%), discoid lupus erythematosus (6.2%), nonclassifiable lymphocytic scarring alopecias (5.6%), frontal fibrosing alopecia (5.3%), and nonspecific NCAs (5%). This contrasted with other richly pigmented populations where discoid lupus erythematosus predominates. Other interesting findings included relatively frequent folliculitis decalvans and lichen planus pigmentosus in 40.9% of frontal fibrosing alopecia cases. Scarring/nonscarring clinicopathologic congruence occurred in 83.4%.Regarding histopathologic features of severity/chronicity, CAs had markedly decreased hair counts. Perifollicular fibrosis affecting retained hairs occurred in 75% of CAs, moderate to severe in >50% of these. Approximately 50% of NCA samples demonstrated advanced miniaturization (T:V ratio <2:1). In our study, relatively young women with chronic hair loss and CA are most frequently biopsied. Central centrifugal CA is the most common diagnosis. Local features of chronic/severe disease are seen microscopically. Clinical impression of scarring/nonscarring correlates well with histopathology.
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Affiliation(s)
- Jonathan D Ho
- Division of Dermatology, Department of Medicine, The University of the West Indies, Kingston, Jamaica W.I.; and
- Department of Pathology, The University of the West Indies, Kingston, Jamaica W.I
| | - Chico J Collie
- Department of Pathology, The University of the West Indies, Kingston, Jamaica W.I
| | - Sherri-Ann Spencer
- Department of Pathology, The University of the West Indies, Kingston, Jamaica W.I
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12
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Palmer V, Valdebran M. Central Centrifugal Cicatricial Alopecia in the Adolescent Population: An Overview of Available Literature. Life (Basel) 2023; 13:life13041022. [PMID: 37109551 PMCID: PMC10142262 DOI: 10.3390/life13041022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/08/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Central centrifugal cicatricial alopecia (CCCA) is a lymphocytic scarring alopecia that predominantly affects women of African descent. Recent studies have demonstrated prevalence in children and adolescents, as well as Asian populations. A thorough search of Pubmed, Cochrane Database of Systematic Reviews, OVID Medline and Google Scholar was conducted using keywords such as "central centrifugal cicatricial alopecia", "scarring hair loss", "scarring alopecia", "hot comb alopecia", "pediatric" and "adolescent". The results yielded few articles in the literature that directly addressed CCCA in the adolescent population, with three articles providing details of the presentation in the form of case series and retrospective reviews. The presentation in the adolescent population was found to be varied, ranging from asymptomatic to symptomatic and involving diffuse to patchy hair loss in only the vertex and/or frontal and parietal scalp. Genetic and environmental etiologies were found to be statistically significant, and markers of metabolic dysregulation predisposing patients to diabetes mellitus and breast cancer were also uncovered. The differential diagnosis of patients who present with hair loss in the adolescent population should therefore be broad, and a low threshold for biopsies should be adopted to confirm CCCA in suspected patients. This will have future implications for reduced morbidity and public health.
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Affiliation(s)
- Victoria Palmer
- King's Medical Center, St. Catherine, Portmore JM00000, Jamaica
| | - Manuel Valdebran
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA
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13
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[Translated article] Trichoscopy: An Update. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T327-T333. [PMID: 36848957 DOI: 10.1016/j.ad.2023.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/18/2022] [Indexed: 02/27/2023] Open
Abstract
Trichoscopy is a simple, noninvasive office procedure that can be performed using a handheld or digital dermatoscope. This tool has gained popularity in recent years, because it provides useful diagnostic information for hair loss and scalp disorders by enabling the visualization and identification of distinctive signs and structures. We present an updated review of the trichoscopic features described for some of the most common hair loss disorders seen in clinical practice. Dermatologists should be familiar with these helpful features, as they can significantly aid the diagnosis and follow-up of numerous conditions, such as alopecia areata, trichotillomania, and frontal fibrosing alopecia.
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14
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Beyond the Hot Comb: Updates in Epidemiology, Pathogenesis, and Treatment of Central Centrifugal Cicatricial Alopecia from 2011 to 2021. Am J Clin Dermatol 2023; 24:81-88. [PMID: 36399228 DOI: 10.1007/s40257-022-00740-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 11/19/2022]
Abstract
Central centrifugal cicatricial alopecia (CCCA) is a form of scarring alopecia that predominantly affects middle-aged women of African descent. Recent data suggest a multifactorial etiology of CCCA that is influenced by environmental and genetic factors. Emerging evidence regarding the genetic basis of the condition may elucidate new therapies. While topical and intralesional steroids and tetracycline antibiotics are the mainstay of treatment, refractory cases may be considered for hair transplantation. Emerging therapies using platelet-rich plasma, botanical formulas, and cosmetic procedures have shown promising results for the future management of CCA. As recent notable advances in CCCA have been achieved, this review provides an update on the epidemiology, pathophysiology, and management of CCCA.
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15
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Fernández-Domper L, Ballesteros-Redondo M, Vañó-Galván S. Trichoscopy: An Update. ACTAS DERMO-SIFILIOGRAFICAS 2022; 114:327-333. [PMID: 36574917 DOI: 10.1016/j.ad.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/07/2022] [Accepted: 12/18/2022] [Indexed: 12/25/2022] Open
Abstract
Trichoscopy is a simple, noninvasive office procedure that can be performed using a handheld or digital dermatoscope. This tool has gained popularity in recent years, because it provides useful diagnostic information for hair loss and scalp disorders by enabling the visualization and identification of distinctive signs and structures. We present an updated review of the trichoscopic features described for some of the most common hair loss disorders seen in clinical practice. Dermatologists should be familiar with these helpful features, as they can significantly aid the diagnosis and follow-up of numerous conditions, such as alopecia areata, trichotillomania, and fibrosing frontal alopecia.
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Affiliation(s)
- L Fernández-Domper
- Servicio de Dermatología, Hospital Clínico Universitario, Valencia, España.
| | | | - S Vañó-Galván
- Unidad de Tricología, Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, España; Unidad de Tricología y Trasplante Capilar, Clínica Grupo Pedro Jaén, Madrid, España
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16
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Larrondo J, Petela J, McMichael AJ. Transitory hair growth using platelet-rich plasma therapy in stabilized central centrifugal cicatricial alopecia. Dermatol Ther 2022; 35:e15798. [PMID: 36042537 PMCID: PMC9786548 DOI: 10.1111/dth.15798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Jorge Larrondo
- Department of DermatologyWake Forest Baptist HealthWinston SalemNorth CarolinaUSA
| | - John Petela
- Wake Forest University School of MedicineWinston SalemNorth CarolinaUSA
| | - Amy J. McMichael
- Department of DermatologyWake Forest Baptist HealthWinston SalemNorth CarolinaUSA
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17
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Ogbuefi N, Erickson T, Mhlaba JM. A case of rapid progression of central centrifugal cicatricial alopecia after COVID-19 infection. JAAD Case Rep 2022; 29:89-91. [PMID: 36101703 PMCID: PMC9458759 DOI: 10.1016/j.jdcr.2022.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - Julia M. Mhlaba
- Correspondence to: Julia M. Mhlaba, MD, Department of Dermatology, Arkes Pavilion, 676 N St Clair St Ste 1600, Chicago, IL 60611. @JMhlabaMD
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