Article summary by Jessica Brown-Korsah | MD Candidate 2024 | Case Western Reserve University School of Medicine

Central centrifugal cicatricial alopecia (CCCA) is a type of scarring hair loss that starts at the vertex of the scalp and progresses outward in a circular pattern. This type of permanent hair loss is believed to have a genetic component, which may put a particular person at a higher risk of developing CCCA and potentially other associated medical conditions or comorbidities.^1,2 Previous studies have noted that CCCA was associated with uterine fibroids, breast cancer, and type 2 diabetes.^3–5 However, whether the findings of these studies are applicable to all individuals with CCCA, or whether other additional medical conditions are associated with CCCA remains controversial.

In a study by Jafari et al., 153 women in New Orleans, Louisiana area with CCCA were studied from January 2011 to December 2021 to look for any comorbidities associated with CCCA.⁶ The rate of comorbidities in patients with CCCA was compared to comorbidities present among patients with non-scarring alopecia with similar demographics. The proportions or percentages of cardiovascular comorbidities, endocrine disorders, autoimmune disorders, hormonally driven diagnoses, and psychiatric diseases were similar between patients with CCCA and non-scarring alopecia. Therefore, the study showed a lack of association between comorbidities and CCCA. Some of the comorbidities studied by Jafari et al. included hypertension, obesity, peripheral artery disease, dyslipidemia, type 2 diabetes, hidradenitis suppurativa, systemic lupus erythematosus, sarcoidosis, Crohn’s disease, vitiligo, Sjogren’s syndrome, and uterine fibroids.

In summary, it is unclear if comorbidities such as type 2 diabetes and uterine fibroids are associated with CCCA. While no association was found in this study between the aforementioned diseases and CCCA, patients should still adhere to recommended screening guidelines as discussed with their primary care physician. The community of CCCA needs larger studies to confirm whether people with CCCA are at an increased risk of developing certain diseases and whether screening recommendations need to change.

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References: 1) Malki L, Sarig O, Romano MT, et al. Variant PADI3 in Central Centrifugal Cicatricial Alopecia. New England Journal of Medicine. 2019;380(9):833-841. doi:10.1056/nejmoa1816614. 2) Dlova NC, Jordaan FH, Sarig O, Sprecher E. Autosomal dominant inheritance of central centrifugal cicatricial alopecia in black South Africans. Journal of the American Academy of Dermatology. 2014;70(4):679-682.e1. doi:10.1016/j.jaad.2013.11.035. 3) Dina Y, Okoye GA, Aguh C. Association of uterine leiomyomas with central centrifugal cicatricial alopecia. JAMA Dermatology. 2018;154(2):213-214. doi:10.1001/jamadermatol.2017.5163. 4) Brown-Korsah JB, Roche FC, Taylor SC. Association of breast and colorectal cancer in patients with central centrifugal cicatricial alopecia: A retrospective, cross-sectional pilot study. Journal of the American Academy of Dermatology. 2021;84(3):859-860. doi:10.1016/j.jaad.2020.10.044. 5) Roche FC, Harris J, Ogunleye T, Taylor SC. Association of type 2 diabetes with central centrifugal cicatricial alopecia: A follow-up study. Journal of the American Academy of Dermatology. 2022;86(3):661-662. doi:10.1016/j.jaad.2021.02.036. 6) Jafari AJ, Brown C, Echuri H, Murina AT. Lack of association between comorbidities and central centrifugal cicatricial alopecia: A retrospective cohort study of 153 patients. J Am Acad Dermatol. 2023;88(2):e101-e103. doi:10.1016/j.jaad.2022.09.056