'Hot comb' alopecia or CCRA: Causes and treatments
Mutations, not hair styling, drives this scarring alopecia in women with Afro-textured hair (1,500 words, 7 minutes)
Central centrifugal cicatricial alopecia (CCCA) is a scarring form of alopecia that predominantly affects women with Afro-textured hair. While no treatments are indicated for the condition, secretome therapy shows promise.
Dr. Renée A. Beach explored these ideas during a presentation at the 9th annual Skin Spectrum Summit.
Dr. Beach practices medical and cosmetic dermatology at DermAtelier on Avenue in Toronto and is an assistant professor at the University of Toronto.
Dr. Beach said the condition can present very late in a patient’s life and can be asymptomatic at first—patients may feel no more than a bit of itch.
Historically often blamed on a patient’s hair styling—the condition was once known as “hot comb alopecia”—it has now been established that CCCA is associated with significant missense mutations, she said.
While CCCA is not caused by hair styling, certain hairstyles such as braids and weaves that pull the hair can affect a patient’s hair, said Dr. Beach.
Dr. Beach said that treatments typically used for managing hair loss, such as oral and topical minoxidil or calcineurin inhibitors, may be helpful if the condition is caught early, as that may help minimize scarring. However, these are all off-label uses, as no indicated treatments exist for CCCA.
Regenerative treatments, such as stem cell secretosome therapy, may be the treatments of the future for CCCA, said Dr. Beach. Secretosomes are considered growth factors, and they support other growth factors.
“What we“are doing [with secretosome therapy] is capturing messenger RNA and injecting it into the scalp to try to change some of the genetic misprogramming that would otherwise make scars,” said D”. Beach.
Bottom line: Women with Afro-textured hair may experience central centrifugal cicatricial alopecia later in life. The condition is caused by genetic mutations rather than hair styling or care practices. There are no on-label treatments for the condition at this time, but common alopecia treatments may be tried, and secretosome therapy is being explored as an option by researchers.
From the literature on hair and scalp in skin of colour
Effect of skin type on efficacy of laser treatment for androgenetic alopecia: A review of the literature
The objective of this literature review study was to systematically assess whether skin type data were collected and analyzed in clinical trials of laser treatment for androgenetic alopecia and to determine if an effect of the treatment could be estimated.
Through a comprehensive literature search, the authors identified and included 22 studies. Of those, 10 had defined inclusion criteria as Fitzpatrick skin types I-IV. No studies mentioned effects on Fitzpatrick skin types V-VI. Only five of those 10 studies had statistical data on efficacy depending on Fitzpatrick skin type, with four showing no effect and one showing a significant positive effect with darker skin types having a faster rate of hair growth.
The authors conclude that there is not enough data to determine whether skin type affects laser-induced hair growth in androgenic alopecia. They note that the existing studies are severely lacking in sample size, and only one showed a potential effect.
Importantly, they found no data on Black or Brown skin colours.
Study ”n the efficacy and safety of a high-power triple wavelength diode laser (810, 940, 1060 nm) for removing fine and less pigmented facial hair on Asian skin
In this single-centre retrospective cohort study, researchers used a high-power triple wavelength diode laser (810, 940, and 1060 nm), with a 2.7 cm² spot size to remove hair on faces with thin and less pigmented hair.
Twenty-three subjects with Fitzpatrick skin types IV and V were included. The investigators measured effectiveness by counting the hairs in high-resolution photos taken before and after the procedure, in addition to the Global Aesthetic Improvement Scale (GAIS). They also created mathematical 3D simulations to compare thermal damage sustained by the hair follicles and epidermal heating.
The researchers observed an average of 66% hair reduction. Patient satisfaction was between 4 and 5 points on the GAIS scale, indicating the treatment was well received and tolerated. They did not observe any adverse side effects.
Alopecia areata clinical trial enrollment and retention outcome factors among underrepresented ethnic and racial groups: A cross-sectional study
The authors of this paper sought to examine enrollment characteristics of alopecia areata (AA) study participants across ethnic and racial groups at a single-centre trial unit.
This study included 115 subjects screened for enrollment in AA therapeutic, randomized clinical trials between 2017 and 2022. Trial subjects were recruited by the following means in order of frequency: university dermatologists, outside dermatologists, and direct marketing efforts.
Of the 115 subjects, 45.2% were identified as White, 24.3% were Hispanic, 16.5% were Asian, 12.2% were Black, and 1.7% were Pacific Islanders. Investigators found significant differences between racial/ethnic groups in “study completion status” (completed, ongoing, or withdrawn/discontinued; p=0.0131). Asian patients had the highest enrollment rates (84.2%) and the lowest screen failure rates (15.8%). In contrast, Black patients had the lowest enrollment rates (42.9%) and the highest screen failure rates (57.1%). Withdrawal and early termination rates were also the highest in Black patients (33% and 16.7%, respectively), but these rates were the lowest in Pacific Islanders (0%).
The authors write that the low enrollment rates of Black patients were due to high screen failure due to incorrect alopecia diagnosis, low Severity of Alopecia Tool score, pregnancy, malignancy, abnormal thyroid levels, hepatitis B, anemia, and inability to attend visits.
Establishing baselines of hair density measurements: Variations across ethnicity, scalp region, and measurement techniques: A systematic review
This systematic review compiles reported normative hair density values for different races and ethnicities, presents their weighted averages, and categorizes these populations based on their geographic distribution globally. Additionally, the authors separate scalp hair measurements according to four major scalp regions.
Researchers analyzed PubMed database entries from 1964 to 2022 for this review to identify studies reporting hair density measurements in healthy individuals without hair or scalp disorders. In total, they screened 1,125 studies and included 40 for final analysis.
Researchers classified hair density measurements into noninvasive (NI), semi-invasive, or invasive (I) methods. NI methods used global hair counts without manipulating hair, while semi-invasive methods such as trichograms involved limited hair shaft physical interaction. Invasive methods, including scalp biopsies, were used for detailed hair density measurements.
The four scalp regions used for analysis were frontal, temporal, vertex or crown, and occipital.
Among the 40 studies included, there were 21,089 hair density measurements: 3,594 frontal, 5,798 vertex, 5,514 temporal, 5,960 occipital, and 223 at unspecified locations, from 6,674 patients, with NI measurement representing the most common techniques (63%). The overall average scalp hair density was 166±61 (hairs/cm2) across 32 populations. When comparing combined mean scalp hair densities taken from NI measurement techniques, the authors found Caucasian subjects in the U.S. have the highest overall density at 211±48, followed by Japanese (Japan) 202±63, African Americans (U.S.) 170±46, Thai (Thailand), 155±35, Korean (South Korea) 153±59, and Chinese (China and France) 141±40. Hair density varied significantly within populations depending on the measured scalp region and the measurement technique employed.
VIDEO: Alopecia areata 101
In this video from the U.S. National Alopecia Areata Foundation, dermatologist Dr. Amy McMichael discusses alopecia areata and balances myths and facts about the condition.
Dr. McMichael is Chair of the Dermatology Department at Atrium Health Wake Forest Baptist Medical Center in Winston-Salem, N.C.
At the intersection of skin and society
A new independently-produced video developed to educate Canadians about Indigenous history was launched on YouTube on April 10, 2024.
Titled Understanding Indigenous History: A Path Forward, the series is hosted by Canadian broadcast journalist Lisa LaFlamme and features interviews with First Nations leader Phil Fontaine and human rights expert Kathleen Mahoney.
According to a press release from University Canada West, which is releasing the series, the program aims to help viewers navigate and understand the complex tapestries of Indigenous history and Truth and Reconciliation in Canada.
“All good” teaching is about transformation—individual, collective, and institutional,” said Fontaine, in the release. “Each of these levels is needed to foster reconciliation for all wrongs done to Indigenous peoples in Canada. We hope this series assists in some small way towards that end.”
The six-part series explores the oral history of the origins of Indigenous peoples before European settlers arrived on the land that became Canada, treaties and the fur trade, the impact of assimilation, leadership and governance within First Nations communities, Indigenous law and the 94 calls to action from the Truth and Reconciliation Commission of Canada.
This week
April 16 is Active Care Planning Day in Canada
April 19 is National Clean Out Your Medicine Cabinet Day in the U.S.
April 21 is World Creativity and Innovation Day
Something to think about in the week ahead. . .
—Potter Stewart, past Associate Justice of the Supreme Court of the United States (1915-1985)
Next week
Dr. Carolyn Jack, assistant professor of dermatology at McGill University in Montreal, discusses some unique atopic dermatitis-related challenges facing Indigenous populations in Canada.
Save the date for the Atopic Dermatitis Summit
On May 11, 2024 from 10 a.m. to 1 p.m. EDT, Skin Spectrum Summit presents the Atopic Dermatitis Summit, a one-day virtual medical education event seeking to provide the highest-quality AD education to help Canadian patients receive the best care possible. Drs. Marissa Joseph and Neil Shear are the co-chairs of the event.
You can join your colleagues to learn more about the incidence of and the latest therapies for AD through live Q&As and lectures.
The Summit is a landmark opportunity to learn to:
Effectively communicate about AD with patient and their families
Diagnose AD across all skin phototypes
Prioritize sun protection in the management of AD
Address disparities among Indigenous communities
Understand the interplay between food allergies and AD
Registering for this compelling event is free, but space is limited. Reserve your (virtual) space now at tinyurl.com/ADSummit2024
Many thanks to L'Oréal, Procter & Gamble, Dermtek Pharma and other event supporters. Learn more at www.skinspectrum.ca/ad
If you like Skin Spectrum Weekly, why not check out ChroniclChronicle’sublications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Drs. Brittany Waller (Regina, Sask.), Charles Lynde (Markham, Ont.), Gurbir Dhadwal (Surrey, B.C.), Ashley O’Toole (Scarborough, Ont.) and Monica Li (Vancouver) discuss new treatments for challenging diseases available or expected in 2024.
Dr. Afsanah Alavi (Rochester, Minn.) details recent research showing a link between lower limb lymphedema and skin cancer.
Drs. Reetesh Bose (Ottawa), Morvarid Hessami (Toronto), and Marissa Joseph (Toronto) describe the establishment of dermatology clinics specializing in skin of colour, and the outcomes they are achieving.
Plus regular features, including the popular column “Vender “n Psoriasis” by dermatologist Dr. Ron Vender.
Read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary* subscription or to receive a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates readers with new findings concerning dermatologic issues affecting women and the female dermatologists who care for them. Read the current issue here.
Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether vitamin D influences psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
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