In this MD Newsline exclusive interview with dermatologist Dr. Victoria Barbosa, we discuss disparities in diagnosing and treating central centrifugal cicatricial alopecia (CCCA) before and during the COVID-19 pandemic.
Main Points in Detail
1. Genetic Component
- Research shows Central Centrifugal Cicatricial Alopecia (CCCA) has a significant genetic basis.
- This means its higher prevalence in Black women is not due to lifestyle disparities but largely inherited risk.
- Example: If a woman’s mother or grandmother had progressive scarring hair loss at the crown, she may be more likely to develop CCCA.
2. Delayed Diagnosis
- Many patients see 2–4 doctors before receiving a proper diagnosis.
- Reasons:
- Some doctors minimize hair loss complaints, prioritizing conditions like hypertension or diabetes.
- Some providers aren’t familiar with CCCA and may mislabel it as “regular hair thinning.”
- Others mistakenly believe nothing can be done for scarring alopecia.
⚠️ Impact: This delay can cause more follicles to scar and reduce chances of regrowth.
Example: A woman in her 30s notices thinning at her crown. After 3 years of misdiagnosis, the hair follicles become permanently scarred, limiting her treatment options.
3. Not Just “Hair Loss” – It Affects Identity
- Hairstyles are deeply tied to self-expression and identity, particularly in Black culture.
- Hair loss can lead to emotional distress, low self-esteem, and even depression.
Example: A professional woman who styles her hair in braids finds her scalp thinning at the crown. She feels forced to wear wigs and becomes self-conscious in work settings.
4. Treatment Options – It’s Not Hopeless
Contrary to older beliefs, CCCA can be managed if caught early:
- Stopping Progression:
- Anti-inflammatory medications (e.g., corticosteroid injections, topical steroids).
- Oral antibiotics with anti-inflammatory effects (like doxycycline).
- Encouraging Regrowth:
- Minoxidil (Rogaine) to stimulate follicles.
- Platelet-rich plasma (PRP) therapy in some cases.
Example: If treatment begins when the follicles are inactive but not yet scarred, patients can see regrowth in those areas.
5. Prevention & Early Action
- Recognizing early signs like itching, burning, or tenderness at the crown is crucial.
- Patients should see a dermatologist who specializes in hair and scalp disorders.
- Education is key—both for patients (to seek help early) and for doctors (to take hair loss seriously).
✅ Summary in Simple Terms:
CCCA is a genetic, scarring hair loss condition common in Black women that starts at the crown and spreads outward. Many women experience delays in diagnosis because hair loss is downplayed or misunderstood. While permanent follicle damage can’t be reversed, early treatment can stop progression and sometimes restore hair. Timely recognition and specialized care make the difference.
