Primary Cicatricial Alopecia: Clinical Features and Management

Elizabeth K. Ross, MD


Dermatology Nursing. 2007;19(2):137-143. 

In This Article

Central Centrifugal Cicatricial Alopecia

This form of primary cicatricial alopecia is seen mainly in African-American women. Former names for the condition are hot-comb alopecia, follicular degeneration syndrome, and pseudopelade in African Americans. The cause is disputed, but some clinicians feel that chronic use of physically and chemically traumatic hair-care practices (for example, chemical straighteners) are involved in its development.

Like pseudopelade of Brocq, symptoms and outward signs of follicular inflammation are usually minimal. However, some patients complain of itch, tingling, or tenderness in the affected scalp. Occasionally, slight perifollicular hyperpigmentation may be seen. The central or vertex scalp is involved, usually starting in the midline. Gradual, symmetric, centrifugal spreading alopecia, in pseudopod-like extensions, occurs over many years. The affected scalp is shiny, flesh-colored, and soft to touch (see Figure 5).

Central centrifugal cicatricial alopecia. Source: Photo courtesy of Paradi Mirmirani, MD.

High-potency topical corticosteroids may be tried first; intralesional injections of triamcinolone are added if the benefit is suboptimal. A combination of topical corticosteroid and an oral tetracycline has also been reported to be effective; the effect may take months to be appreciated. Although cessation of traumatic hair-care practices may not impact the course of disease, the patient should be advised to adopt gentle hair care. If hair breakage is also present, the use of heat, chemicals, and traction should be minimized or avoided.


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