title: Central Centrifugal Cicatricial Alopecia in Children: A Case Series and Review of the Literature.
abstract: OBJECTIVE
  Central centrifugal cicatricial alopecia (CCCA) is a form of scarring hair loss most commonly seen in middle-aged African and African American women. It is rarely reported in children. The objective of the current study was to document the presence of CCCA in children and to encourage physicians to recognize early signs of CCCA in children of affected adults.
  
  
  METHODS
  Six children presented with biopsy-proven CCCA to the Department of Dermatology at Wake Forest Baptist Health and the Nelson R. Mandela School of Medicine from 2012 to 2015. Demographic characteristics, hair styling history, and family history of CCCA were noted. Examination included complete history, skin and scalp examination, photographs of the scalp, and scalp biopsies.
  
  
  RESULTS
  Patient ages ranged from 14 to 19 years (mean age at onset 14 years). Five patients reported scalp symptoms such as tender papules, pruritus, and scaling. Four patients reported appreciable hair loss on the vertex of the scalp. One patient had used chemical relaxers and hair dyes in the past. Five patients had a known family history of CCCA.
  
  
  CONCLUSIONS
  Because CCCA is not typically seen or suspected in children, it is likely to be misdiagnosed or underreported. The findings in these cases add weight to the concept that genetic susceptibility rather than hair care practices may play a significant role in causing CCCA.
authors.affiliation: Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: Ariana N
authors.initials: AN
authors.lastname: Eginli
authors.affiliation: Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Ncoza C
authors.initials: NC
authors.lastname: Dlova
authors.affiliation: Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: Amy
authors.initials: A
authors.lastname: McMichael
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000505:Alopecia / Q000473:pathology* / Q000628:therapy; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D055815:Young Adult