Objective: African American women often present with unique types of hair loss including traction alopecia, central centrifugal cicatricial alopecia (CCCA), discoid lupus, folliculitis decalvans and dissecting cellulitis. In addition, other conditions without racial predilection such as alopecia areata, lichen planopilaris and telogen effluvium can also be seen in this population. The goal of this study was to determine the frequency of the various alopecias in African American women seen at the Cleveland Clinic over a ten-year period and identify any risk factors including environmental and medical risk factors for each type of hair loss.
Methods: A retrospective chart review was completed from patients seen at the Cleveland Clinic from 1999 to 2009. Data compiled from the chart review included information about past medical history, hair care practices, laboratory findings, and any presenting symptoms of the patients.
Result: CCCA was the most common hair disorder in Black women seen at the Cleveland Clinic, followed by androgenetic alopecia, and traction alopecia. More than 50% of patients with the diagnosis of CCCA had a history of chemical relaxer use. Diabetes mellitus type II and anemia was more prevalent in African American women with CCCA although it was not statistically significant. The average onset of CCCA was coincident with that of adrogenetic alopecia.
Conclusion: CCCA was the most common hair disorder diagnosed in black women followed closely androgenetic alopecia. The fact that the age of onset of CCCA is coincident with that of androgenetic alopecia and the fact that they are often clinically indistinguishable begs the question of any relationship between the two entities such as a common hormonal trigger. This study confirms the clinical impression that CCCA is the most common scarring alopecia seen in African American patients and also raises questions about the possible role of hormones in its pathogenesis.