Central Centrifugal Cicatricial Alopecia Presenting with Irregular Patchy Alopecia on the Lateral and Posterior Scalp.

Background: Central centrifugal cicatricial alopecia (CCCA) is the most common cause of scarring alopecia among women of African descent which affects the central scalp and spreads centrifugally but spares the lateral and posterior scalp.
Objectives: The objective of this study is to report on a new clinical variety of CCCA presenting with patchy alopecia involving the lateral and posterior scalp in addition to the central scalp.
Materials and Methods: We reviewed the medical records and the clinical, dermatoscopic and pathologic data of 14 African-American women with CCCA presenting with patchy alopecia.
Results: Two patients had individual well-delineated patches of hair loss, and 12 patients had multiple irregular patches of hair loss. In all cases, the alopecia affected the lateral and posterior scalp in addition to the central scalp. Four patients had a history of traumatic hairstyles, and 10 patients were also affected by marginal traction alopecia. On dermatoscopy, the patches showed peripilar white-gray halos and broken hairs. The pathologic diagnosis of CCCA was based on the following features: follicular dropout, absent or only focally preserved sebaceous glands, premature desquamation of the inner root sheath and perifollicular fibrosis with mild inflammatory infiltrate.
Conclusion: CCCA can present with patches of hair loss involving the parietal and posterior scalp in addition to the central scalp. Without dermatoscopy and pathology, this variety can be easily misdiagnosed as traction alopecia.