African Americans are found to be at increased risk. Historically, some have hypothesized that CCCA represents an end stage of traction alopecia. However, the veracity of this theory is low as many patients who have CCCA have not employed traction hairstyling. Histopathologic features
Histopathologic features include a perifollicular lymphocytic infiltrate, concentric lamellar fibrosis (layers of fibroblasts in the papillary dermis), sebaceous gland loss and premature disintegration of the internal root sheath. Additionally, granulomatous inflammation secondary to follicular rupture has been noted. Perifollicular erythema and follicular keratosis is usually absent. Treatment
Treatments for CCCA remain investigational. Altering hair care practices has not been proven to assist in hair rejuvenation. High-dose topical steroids, antibiotics, immunomodulators such as tacrolimus (Protopic) and pimecrolimus (Elidel), and anti-androgen/5alpha Reductase inhibitors have been used with unknown efficacy. : 648–9 : 760

Epidemiology
CCCA tends to present itself in the 20s and progresses over 20–30 years. One should consider this diagnosis in African Americans with what appears to be a female-pattern hair loss. Terminology
The terminology of CCCA has been a source of regular confusion. Recent clarifications have been made, with the term "central centrifugal cicatritial alopecia" adopted as a diagnostic category by the North American Hair Research Society. It has also been referred to as:
Hot comb alopecia
Follicular degeneration syndrome
Pseudopelade in African Americans
Central elliptical pseudopelade in CaucasiansAlso in this category is cicatricial pattern hair loss (CPHL). This CCCA pattern is a potential alopecia mimic that can be confused for androgenetic alopecia.
Tretinoin/benzoyl peroxide, sold under the brand name Twyneo, is a fixed-dose combination medication used for the treatment of acne. It contains tretinoin, a vitamin A derivative, and benzoyl peroxide, an oxidizing agent.The combination was approved for medical use in the United States in July 2021. References
External links
"Tretinoin". Drug Information Portal. U.S. National Library of Medicine. "Benzoyl peroxide". Drug Information Portal. U.S. National Library of Medicine. Clinical trial number NCT03761784 for "A Study of S6G5T-3 in the Treatment of Acne Vulgaris" at ClinicalTrials.gov
Clinical trial number NCT03761810 for "A Study of S6G5T 3 in the Treatment of Acne Vulgaris" at ClinicalTrials.gov