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Therapeutic Approach

Central centrifugal cicatricial alopecia (CCCA) is a primary, progressive scarring alopecia almost exclusively presenting in women of African descent. Unlike other forms of cicatricial alopecia where clinical signs of inflammation can be used to guide therapeutic approach, the inflammation in CCCA is often subclinical and warrants aggressive treatment to slow or halt disease progression. The treatment of CCCA can be thought of in 2 phases: anti-inflammatory (aimed at controlling inflammatory infiltrate) and maintenance (aimed at sustaining disease stability). In some cases, early initiation of treatment can save hair follicles that have not fully succumbed to fibrosis. As a result, patients may experience increased follicular density and hair regrowth in areas previously thought to represent end-stage scarring. In the authors’ experience, initiating treatment with high-potency topical steroids 3-5 times per week + intralesional triamcinolone acetonide is effective at halting disease progression. Oral doxycycline or minocycline can be effective in patients with more symptomatic disease. See Table 81-1.

Table 81-1CCCA Treatment Table

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