Discuss the mechanism of central, centrifugal, cicatricial alopecia (CCCA).

The most common form of cicatricial alopecia in black patients was once called “hot comb alopecia” but is now called central, centrifugal, cicatricial alopecia (CCCA). The condition more often affects adult women than men and typically causes hair loss that is most severe on the central crown of the scalp and slowly progresses centrifugally (see Fig. 20-1). When the bald patches are carefully examined, a few normal hairs may be found, but most follicular openings have been completely obliterated, suggesting a cicatricial process. Scattered inflammatory, perifollicular papules may be found in the peripheral zone where hair thinning has just begun. Scalp biopsy confirms that hair follicles are completely destroyed and replaced with fibrous tissue. “Hot combs” are rarely used nowadays for straightening hair, so hot comb alopecia is a misnomer. It is uncertain whether hair care products are primarily responsible for hair loss in these patients, but chemical relaxers and other cosmetics may exacerbate the condition.

Sperling LC, Solomon AR, Whiting DA: A new look at scarring alopecia, Arch Dermatol 136:235–242, 2000.