Case Report: Managing Scarring Hair Loss in a 60-Year-Old Woman with CCCA and Traction Alopecia
Scarring hair loss in women—especially African American women—is one of the most challenging conditions to diagnose and treat. At Reena Jogi MD Dermatology in Houston and Katy, Texas, we often see patients with central centrifugal cicatricial alopecia (CCCA) and traction alopecia, both of which can be difficult to reverse without expert care. This case features a 60-year-old female patient with a complex history of treatments and slow response, who is now on a refined regimen tailored to her hair biology and long-term goals.
Chief Complaint: Longstanding Focal Hair Loss
The patient presented with moderate, focal hair loss that had been gradually progressing over several years. Her areas of concern included the central scalp, frontal hairline, and parietal regions. She had previously undergone:
4 sessions of PRP therapy
Intralesional steroid (ILK) injections
Oral and topical metformin, spironolactone, bicalutamide, and doxycycline
Despite these interventions, progress had plateaued. At presentation, she was using:
Oral minoxidil 2.5 mg daily
Viviscal supplements
Clinical Examination and Diagnosis
A focused exam with dermatoscopic support revealed:
Scarring alopecia with follicular dropout at the central and frontal scalp
Signs of peripheral traction alopecia along the edges of the scalp
No signs of pustules or active inflammation
Diagnosis:
Central Centrifugal Cicatricial Alopecia (CCCA) – L66.81
Traction Alopecia – L65.8
This scarring pattern is common among African American women, often resulting from chemical relaxers, tight hairstyles, or heat styling. In this case, both genetic and mechanical factors were likely contributors.
Treatment Strategy: Inflammation Control + Hair Stimulation
After a detailed discussion and informed consent, we designed a personalized plan:
✅ 1. Restart Doxycycline (40 mg daily)
To help reduce inflammation, doxycycline was reintroduced at a lower anti-inflammatory dose. The patient was counseled on sun sensitivity and rare side effects, with full understanding of proper usage.
✅ 2. Continue and Optimize Oral Minoxidil (2.5 mg)
Patient remained on oral minoxidil, which had been well tolerated. We discussed dose flexibility, benefits in scarring alopecia, and rare cardiovascular risks like pericardial effusion.
✅ 3. Switch to Nutrafol Women's Balance
To improve nutritional support and hormonal balance, the patient transitioned from Viviscal to Nutrafol, which offers ingredients targeted to peri- and post-menopausal women.
✅ 4. Consider Alma TED and LLLT (Low-Level Laser Therapy)
Although the patient declined further PRP for now, she received a handout on Alma TED, a newer, non-invasive ultrasound-based treatment for hair growth, and was advised on laser caps for home use.
Additional Counseling
Traction Alopecia is irreversible in many cases but can be arrested. The patient was advised to avoid tight styles, braids, or ponytails.
Hot combs and chemical relaxers should be discontinued to prevent additional follicular injury.
Continued use of gentle shampoos and avoidance of scalp irritants was emphasized.
Conclusion: Thoughtful Care for Complex Female Hair Loss in Houston and Katy
This case reflects the multifactorial nature of scarring hair loss in mature women. Despite failure with several therapies, the patient remains motivated and optimistic due to the collaborative approach and clear expectations. At Reena Jogi MD Dermatology, we guide patients through every phase of their journey—offering cutting-edge treatments and compassionate expertise.
If you’re struggling with hair loss that doesn’t respond to over-the-counter options, schedule your consultation today with our Houston or Katy offices.
