Purpose: Central Centrifugal Cicatricial Alopecia (CCCA) is the most common type of scarring alopecia affecting black women. The purpose of this study is to investigate potential risk factors such as family history of hair loss, hair grooming practices, comorbid medical conditions including infection, hormonal imbalance and autoimmune diseases and their role in the development of CCCA.
Method: A questionnaire about risk factors standardized by the North American Hair Research Society (NAHRS) for evaluation of CCCA was administered to 326 African American women. This was followed by a scalp exam using NAHRS CCCA hair loss scales to grade hair loss. Answers to the questionnaire were compared with the graded hair loss scales to determine if there is a relationship between the development of CCCA and these risk factors.
Results: There were 326 responders. Of these 92% used chemical relaxers. Twenty-eight percent (28%) received a grade of 2+ using the NAHRS CCCA grading scale, a score consistent with clinically evident CCCA. Of these, advanced CCCA (grade 3-5) was seen in 59% of these respondents. Ninety-four percent (94%) of those with clinically evident CCCA (grade 2+) had history of chemical relaxer use. There was also an increased rate of adult acne, difficulty getting pregnant, bacterial skin infections and diabetes mellitus type II in those with advanced CCCA (grade 3+) as compared to those without CCCA.
Conclusions: This study suggests that while hair grooming practices may be a risk factor for CCCA, inflammation in the form of bacterial infection and acne may also play a role. Of note the over representation of diabetes mellitus in those with advanced CCCA suggests a possible autoimmune etiology. It is also interesting that there is an increase in adult acne and pregnancy difficulties in those with advanced CCCA, suggesting that hormones may also play a role.