Central centrifugal cicatricial alopecia in males

Abstract

Background: Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia seen primarily in women of African descent but rarely reported in men. The etiology of CCCA is unknown, but genetic variants, type 2 diabetes mellitus, and bacterial infections may play a role.

Objectives: We aimed to characterize the demographics, medical histories, and clinical findings of male patients with CCCA with the hypothesis that features may differ from women.

Methods: This was a case series of adult male patients with biopsy-confirmed CCCA seen at an academic dermatology department between 2012 and 2022.

Results: In total, 17 males had a scalp biopsy and clinical findings consistent with CCCA. The average age was 43 years, and 88.2% of cases identified as Black race. Scalp pruritus was the most common symptom, and few patients endorsed high-risk hair care practices. None of the cases had diagnosis of type 2 diabetes mellitus, but 17.6% had history of latent tuberculosis, and 47.1% had a positive family history of alopecia. We observed 8 patients with atypical CCCA, and 29.4% had an overlapping scalp diagnosis.

Limitations: This study is limited by the single center, retrospective design and small sample size.

Conclusions: It is important to consider CCCA in the differential diagnosis of alopecia in adult Black males.

Keywords: CCCA; alopecia; atypical presentation; case series; central centrifugal cicatricial alopecia; cicatricial alopecia; dermatology; hair loss; males; men; scarring alopecia; subtype.