Medical and Environmental Risk Factors for the Development of Central Centrifugal Cicatricial Alopecia A Population Study

Objective: To investigate medical and environmental risk factors for central centrifugal cicatricial alopecia (CCCA), the most common type of scarring alopecia in African American women. Design: A population study involving a quantitative cross-sectional survey of risk factors for CCCA. Survey results are then correlated with a clinical evaluation for CCCA using a standardized, previously published central scalp alopecia photographic scale. Setting: Two African American churches and a health fair for African American women in Cleveland, Ohio. Participants: A total of 326 African American women who participated in the hair study. Main Outcome Measures: Prevalence of CCCA in the general African American population and risk factors associated with CCCA. Results: Of the 326 responders, 28% received a grade of 2 or higher using a standardized, previously published central scalp alopecia photographic scale, a score consistent with clinically evident central hair loss. Advanced central hair loss with clinical signs of scarring (grade >= 3) was seen in 59% of these respondents and was interpreted as clinically consistent with CCCA. Diabetes mellitus type 2 was significantly higher in those with CCCA (P=.01), as were bacterial scalp infections (P=.045) and hair styles associated with traction (eg, from braids and weaves) (P=.02). Conclusions: Our survey results suggest that there is a high prevalence of central hair loss among African American women. Hair styles causing traction as well as inflammation in the form of bacterial infection may be contributing to the development of CCCA. The increase in diabetes mellitus type 2 among those with CCCA is in line with the recent theory that cicatricial alopecia may be a manifestation of metabolic dysregulation.