Central Centrifugal Cicatricial Alopecia (CCCA) in a 67-Year-Old Woman: Managing Scarring Hair Loss in Katy & Houston, Texas
Hair loss that progresses slowly over years can be especially distressing—particularly when it involves scarring alopecia, where early treatment is critical to preserving remaining hair. At Reena Jogi MD, we specialize in diagnosing and managing complex hair loss conditions, including Central Centrifugal Cicatricial Alopecia (CCCA), a condition most commonly affecting women of African descent.
This case highlights a 67-year-old female with long-standing hair loss previously diagnosed as CCCA, illustrating a comprehensive, multi-modal approach to treatment and stabilization.
Patient Presentation
A 67-year-old woman presented as a new patient for evaluation of generalized, gradually progressive hair loss on the scalp. She reported that her hair loss had been ongoing for several years and had previously been clinically diagnosed with CCCA by another dermatologist.
Prior Treatments
Multiple sessions of intralesional kenalog (ILK) injections
Oral antibiotics
Compounded topical minoxidil (discontinued)
Currently using clobetasol ointment, with mild improvement noted
Clinical Examination
A focused dermatologic examination of the scalp and face was performed using dermoscopy.
Key Findings
Scarring alopecia involving the central scalp/vertex
Hair loss distributed across:
Posterior mid-parietal scalp
Mid-occipital scalp
Left medial frontal scalp
Clinical features consistent with active CCCA
Evidence of underlying androgenetic alopecia (AGA) contributing to overall thinning
Diagnosis
1. Central Centrifugal Cicatricial Alopecia (CCCA)
CCCA is a chronic scarring alopecia that leads to permanent hair follicle destruction if untreated. It often begins at the crown and spreads outward in a centrifugal pattern.
2. Androgenetic Alopecia (AGA)
In this patient, androgenetic alopecia was identified coexisting with CCCA, contributing to diffuse non-scarring thinning alongside permanent scarring hair loss.
Treatment Discussion & Shared Decision-Making
The diagnosis and prognosis of CCCA were reviewed in detail. The patient was educated on the importance of controlling inflammation to prevent further permanent hair loss.
Treatment Options Discussed
Restarting oral antibiotics
Plaquenil (hydroxychloroquine)
Resuming ILK injections
Topical or oral metformin
Continued topical corticosteroids
After extensive counseling, the patient elected a conservative but targeted approach.
Treatment Plan
CCCA Management
Continue clobetasol ointment applied to affected scalp areas 2–3 times per week
Start oral metformin ER 500 mg once daily
Increasing evidence supports metformin’s anti-inflammatory and anti-fibrotic role in scarring alopecia
Discontinue damaging hair practices (e.g., heat, relaxers)
Androgenetic Alopecia Management
Given her post-menopausal status and underlying patterned thinning:
Start finasteride 5 mg once daily
Reviewed risks including low libido, breast tenderness, and mood changes
Emphasized that finasteride helps preserve existing hair, not regrow scarred follicles
Patient Counseling & Expectations
The patient was counseled extensively on:
Hair care modifications to prevent progression
The scarring nature of CCCA, emphasizing early inflammation control
The slow but progressive nature of androgenetic alopecia
Importance of consistent treatment and follow-up
She was advised to contact the office if symptoms worsen or if side effects occur.
Follow-Up Plan
Return visit in 3 months for reassessment of disease activity
Consider escalation to ILK injections or PRP if inflammation persists
Ongoing monitoring for stabilization rather than regrowth in scarred areas
Expert Care for CCCA in Katy & Houston, Texas
CCCA requires early recognition, patient education, and individualized treatment to prevent irreversible hair loss. At Reena Jogi MD, we offer advanced diagnostic tools and comprehensive treatment options for both scarring and non-scarring alopecia.
If you are experiencing crown-centered hair loss, scalp tenderness, or thinning that isn’t improving, expert evaluation can make a meaningful difference.
