While some persons do not have symptoms, tenderness, itch and burning are common. Hair breakage may also be an early sign of CCCA. Hair loss is slowly progressive. A photographic scale has been developed to rate the severity of the central hair loss.
Noticeable hair loss: Center of the scalp
The first sign is usually noticeable hair loss in the center of the scalp. This is why you see the word “central” in the name. Instead of developing one patch in the center of the scalp, a few people with CCCA develop scattered patches of hair loss on their scalp.
CCCA typically begins as a slight patch of hair thinning on the midline of the crown (top) of the scalp. Over time, the patch expands outwards in all directions (described as a centrifugal pattern) and the severity of hair loss increases, with the most severe hair loss remaining in the center.
Various hairstyling practices have been studied as potentially causing CCCA, but none has been definitively linked to the condition. A combination of factors such as infections (bacterial and fungal), genetics, autoimmune disease, and other unknown factors may play a role in this disease.
What is scarring alopecia? Scarring alopecia, also called cicatricial alopecia, is a type of hair loss caused by the destruction of your hair follicles (shafts on the surface of your skin that hair grows through). It's usually the result of infections, chemicals, burns or autoimmune disorders.
Hair typically falls out in small, round patches about the size of a quarter, but in some cases, hair loss is more extensive. Most people with the disease are healthy and have no other symptoms. The course of alopecia areata varies from person to person.
Testing for vitamin D deficiency should be considered in patients with alopecia due to its high prevalence. While supplementation is controversial, we recommend giving cholecalciferol 50,000 IU once weekly for 12 weeks followed by 2,000 IU daily.
One good indicator of scarring alopecia is a ragged edge around the patch, but since irritated patches don't always form, a small biopsy is usually performed to detect inflammatory cells around your hair follicles that may indicate scarring alopecia.
Indeed, CCCA itch is often accompanied by burning, tenderness and/or pricking sensations1,2 that appear to correspond to sensations accompanying cowhage-induced itch. Cowhage spicules elicit itch by stimulating protease-activated receptor (PAR)-2 in the skin.
So dead hair follicles can look like a smooth, bald patch of skin or like a scar. A trichologist may be able to get a better view of your follicles by using a microscope or other trichological tools.
In the early stages of traction alopecia, the hair loss may be mild, with minimal thinning in the frontal hairline that regrows after discontinuing the traction-related hairstyles. People may feel tenderness, stinging, or pain in the area of hair loss.
What is the age of onset of CCCA? The onset of CCCA is very slow, typically developing over the course of years. Patients usually present with thinning and balding of the scalp in their second to fourth decade of life.
Scarring alopecia (scalp discoid lupus erythematosus) can be the presenting manifestation of lupus in more than half of affected individuals.
Oral doxycycline (or other tetracycline antibiotics) up to 200 mg per d is appropriate (alone or in combination) up to 6 mo in the treatment of adults with active CCCA. Oral antibiotics are appropriate (alone or in combination) for treatment of adults with active CCCA.
Symptoms of Cicatricial Alopecia
Hair loss may develop slowly over years with too few symptoms to notice. In some people, it progresses rapidly over months, causing burning and itching.
While ACV is scientifically proven to help with dry scalp and dry hair, it doesn't have the backing for treating conditions like androgenic alopecia (AKA male pattern baldness).
While hairstyles and hair grooming may play a role in causing CCCA, this has yet to be proven. For example, it's known that using chemical relaxers can weaken the hair, which can lead to hairs breaking off. However, dermatologists have found that some women who develop CCCA have never used relaxers.
Creams, lotions, shampoos or ointments that control inflammation. Your health care provider might prescribe a prescription-strength corticosteroid you apply to the scalp or other affected area. These include hydrocortisone, fluocinolone (Capex, Synalar), clobetasol (Clobex, Temovate) and desonide (Desowen, Desonate).
Dandruff shampoo: This helps reduce scaling on your scalp. Gentle hair care practices: This includes natural styling (i.e., chemical and heat-free), reducing the use of relaxers, and limiting styling products to prevent inflammation and hair damage.
Stage 1: There's little or no hair loss or hairline recession. Stage 2: There's slight hair loss near the skin between your ears and forehead (temples). Stage 3: You have deep hairline recession around your temples, and your hairline may have an “M” or “U” shape.
Pull Test and Tug Test
During a pull test, a dermatologist grasps small sections of hair, about 40 strands, from different parts of the scalp and gently tugs. If six or more strands fall out, you have what's known as active hair loss.