title: Hair breakage as a presenting sign of early or occult central centrifugal cicatricial alopecia: clinicopathologic findings in 9 patients.
abstract: BACKGROUND
  Central centrifugal cicatricial alopecia is the most common form of cicatricial alopecia in African American women. Treatment options are limited and mostly aimed at halting further hair loss but rarely result in hair regrowth. Therefore, it is important to recognize early clinical signs, perform a confirmatory biopsy, and begin treatment promptly. We have observed that hair breakage may be a key sign of early central centrifugal cicatricial alopecia, and this association is not clearly described in the literature.
  
  
  METHODS
  Nine patients with hair breakage on the vertex with or without scalp symptoms underwent scalp biopsies as part of their evaluation. Of these, 8 had histologic samples adequate for complete interpretation: 5 specimens (63%) showed histologic changes typical of central centrifugal cicatricial alopecia, with 1 of these showing advanced end-stage changes of cicatricial alopecia. Two (25%) revealed premature desquamation of the inner root sheath as the sole finding suggestive of early central centrifugal cicatricial alopecia and 1 (13%) was normal.
  
  
  CONCLUSIONS
  Although hair breakage can have multiple causes, early central centrifugal cicatricial alopecia must be considered in the differential diagnosis, particularly in women of African ancestry. Histologic evaluation may reveal early or late findings that can help establish the diagnosis.
authors.affiliation: Callender Dermatology and Cosmetic Center, Glenn Dale, Maryland 20769, USA. drcallender@CallenderSkin.com
authors.forename: Valerie D
authors.initials: VD
authors.lastname: Callender
authors.forename: Dakara Rucker
authors.initials: DR
authors.lastname: Wright
authors.forename: Erica C
authors.initials: EC
authors.lastname: Davis
authors.forename: Leonard C
authors.initials: LC
authors.lastname: Sperling
mesh_terms: D000328:Adult; D001741:Black or African American; D000505:Alopecia / Q000150:complications / Q000175:diagnosis*; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D006197:Hair / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies