# Central Centrifugal Cicatricial Alopecia: A Survey of Treatment Practices Among Dermatology Residents and Attending Physicians

## TL;DR

This study surveys dermatologists about their treatment approaches for a type of hair loss called central centrifugal cicatricial alopecia and compares their practices to existing guidelines.

## Contribution

The study provides insight into real-world treatment practices and provider confidence in managing central centrifugal cicatricial alopecia.

## Key findings

- Topical corticosteroids were the most frequently used first-line treatment for CCCA.
- Topical minoxidil was used first-line by 77.3% of respondents.
- Only 56% of respondents used oral tetracyclines for CCCA treatment.

## Abstract

Introduction

Central centrifugal cicatricial alopecia (CCCA) is a type of primary scarring alopecia characterized by hair loss on the vertex of the scalp. While treatment often focuses on reducing inflammation, no established standard of care exists. Early diagnosis and intervention are critical, as advanced stages with permanent follicular scarring are challenging to treat. Our study aims to assess CCCA treatment practices and provider confidence among dermatology residents and attendings in an urban academic setting. We further compare these real-world practices with existing literature.

Methods

We conducted a cross-sectional survey study of the commonly prescribed/recommended treatments for CCCA in 31 residents and attending physicians at two dermatology programs. Of those, 26 indicated that they see patients with CCCA, comprising 17 residents and nine attending physicians.

Results

Overall, the most frequently utilized therapies for CCCA were topical corticosteroids (TCS) (n = 26), designated as first-line by 90.5% of users, topical minoxidil (n = 24), used first-line by 77.3%, and intralesional corticosteroids (n = 24), used first-line by 65% of users. Oral tetracyclines were used by only 56% (n = 14) of respondents.

Discussion

Our findings mostly align with the current recommendations in the literature, focusing on reducing inflammation with topical and intralesional corticosteroids. Interestingly, topical minoxidil was used first-line by most respondents, possibly reflecting its greater accessibility to our patient population. The discrepancies in our findings may be reflective of variability in provider comfort in CCCA management, concern for side effects of systemic treatments, and presentations of later, “burnt-out” stages of CCCA.