Finding consensus: Simplified classification of cicatricial alopecia needed

January 1, 2009

Finding a consensus on the classification of cicatricial alopecia can help physicians better communicate with each other. Quicker recognition of disease will allow patients to be treated earlier and improve treatment outcomes.

Key Points

Cicatricial alopecia, also called "scarring alopecia," is a little-known subgroup of hair loss in which the hair follicles are permanently destroyed, with little to no chance of hair re-growth. Many specialists choose to classify this subgroup of alopecia based on clinical symptoms and not on histologic findings - the current working classification - as many dermatologists could possibly better identify with the disease and the presenting symptoms.

According to Leonard Sperling, M.D., of the department of dermatology, Uniformed Services University, Bethesda, Md., the five fairly distinctive forms of cicatricial alopecia include chronic, cutaneous lupus erythematosus (discoid LE), lichen planopilaris, dissecting cellulitis (perifolliculitis abscedens et suffodiens), folliculitis keloidalis and central, centrifugal scarring alopecia (follicular degeneration syndrome, folliculitis decalvans, pseudopelade).

Central centrifugal cicatricial alopecia (CCCA) is one of the most common forms of cicatricial alopecia and, therefore, the dermatology community should be more familiar with the disease entity to better treat their patients.

"CCCA is an all-encompassing term that has made it easier for dermatologists to diagnose and come up with treatment for the very large group of patients that fall into this category, most of whom are African American patients, though other racial groups can be affected as well.

"Dermatologists who practice across the country where there are not that many African-Americans, logically, are much less familiar with the diagnosis of CCCA, simply because they see it much less frequently," Dr. Sperling tells Dermatology Times.

Women (much more than men) usually manifest the disease in their early 20s; however, most patients first seek help in their 40s, after they have developed an obvious thinned-out area on the scalp.

The original name for CCCA was "hot-comb alopecia," because of the initial belief that the alopecia was due to the thermal damage to the scalp by a hot-comb device.