Central centrifugal cicatricial alopecia (CCCA) is a condition of the scalp where scarring of the scalp skin is involved. It is not necessarily a common occurrence but its development on unsuspecting individuals is on the rise. It is non-infectious and known to be related to other medical conditions that affect both men and women, however, it can be seen more in women and this could simply be due to the attention, emphasis and time we women place on our hair, in addition to the many processes we put our hair and scalp through.
It can be seen in persons of all ages, but is more commonly seen in the young adult and adult age groups. CCCA can initially start with hair loss most of the time in the center of the scalp. One would notice over time that hair keeps falling out whether it is being combed or not. It can occur gradually over a period of months and years without any warning. Numerous goose bump-like lesions may be felt or even seen around the hair follicles in association with itching, burning and/or sometimes pain of the affected area, that can rapidly progress throughout the scalp horizontally, vertically, or move down the hair follicle causing destruction to the hair shaft.
The now destroyed hair becomes replaced by scarred tissue which prevents hair from growing in this area permanently. Additionally, the affected scalp can show signs of redness, scaling, flaking, inflammation and/or an increase or decrease in pigmentation, pustules or abscesses in the scalp that join together and form tracks, depending on the severity.
Well you may be wondering what kind of person would have such a scalp condition. CCCA is poorly understood but has links to things we females and sometimes males like to do. In our population it is seen more in the black female. We females want our hair to look and feel a certain way most of the time so we relax, straighten, hot curl, hot comb, rinse, weave, braid, dye and bleach our hair somewhat regularly to achieve a certain look throughout our lifetime.
Now it is hard to tell women what to do with their hair, after all "it's yours", but I can advise you on the frequency these enjoyable and desirable processes should be carried out in order to prevent or decrease the development of this scalp condition. In the case of relaxing the hair for example, normally the time to relax should not go beyond 20 minutes depending on the texture.
We all know that that time rule is not necessarily adhered to in any setting, whether at the salon or at home, because the idea is to get the hair as bone straight as possible, to prevent the "peas or naps" from turning back, so to speak, too early. The processing over time degrades the hair shaft, irritating the scalp's skin which sometimes develops sores, bumps and pustules. This leads to hair that is more fragile and easily breakable, which can fall out easily. Thus as a person ages and the same relaxing practices are continued, more hair will appear to fall out and bald patches will start to occur due to scalp irritation or scarring that would have occurred when the scalp skin was irritated.
So it is advised to relax the hair every 8 to 12 weeks as opposed to every 4 to 6 weeks. Similarly with hair that is braided or weaved, in most cases people may be unaware of how tightly the hair is actually weaved or braided. When you notice goose bump-like pimples around the hair line or throughout the scalp, particularly in children, that is an indication of the scalp hair being weaved too tight. The bumps around the hair is a sign of inflammation and irritation of the hair follicle, which is happening around the hair and over time with repetitive tight braiding the growing hair, particularly around the hairline, becomes slow growing, fragile and easily breakable, which can appear to move the forehead hairline further and further back. Now this isn't the case for everyone but it occurs in many women, children and some men.
I know the above mentioned processes and styling techniques have been done for years, from childhood in most cases to adulthood, but they are not necessarily good. However, depending on how irritated or inflamed, scaled, flaked or bumpy the scalp skin is, this could make a difference in the scalp skin either being scarred, with no hair growing back, or non-scarred and possibly able to grow hair again.
It is wise to seek the attention of the dermatologists if this condition is suspected based on the information mentioned, to prevent permanent hair loss and/or scarring, or just simply to address any form of scalp irritation, infection and/or discomfort. The right shampoos, creams, gels, oral medications or intralesional injections would be prescribed based on what is examined on the scalp. In addition the use of the many hair accessories on the market today such as wigs are recommended, in order to allow the hair time to rest and grow without constant manipulation.
• Dr. Rokeisha Clare-Kleinbussink studied at Cosmetology Cosmetic Training for Dermal Filler in London, U.K. and attended the Academy of Beauty Training for Laser and Microdermabrasion in Nottinghamshire, U.K. She also attended the University of the West Indies School of Medicine and Cardiff University School of Medicine. She has a private practice at Roseona House of General and Cosmetic Dermatology and can be reached at www.roseonahouse.com or 422-2022
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