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Scalp Symptoms Important in Identifying Cicatricial Alopecia Subtype
The findings may facilitate accurate diagnoses, which could help patients slow or stop permanent hair loss.
New research has found that scalp symptoms are significantly associated with specific cicatricial alopecia subtypes, highlighting the importance of assessing symptoms in clinical evaluations.1
“Cicatricial (scarring) alopecias are a group of rare, chronic conditions that cause permanent hair loss, and symptoms such as itching, tenderness, and dysesthesia may contribute to poorer quality of life among cicatricial alopecia patients. Scalp symptoms may play a critical role in assessing disease severity, yet there is limited literature on cicatricial alopecia symptomatology. Early identification and disease-specific treatment are essential for halting disease progression and preventing irreversible follicular damage,” lead investigator Noelle Desir, BA, MD candidate, Skin of Color Dermatology Research Fellow, University of Pennsylvania Perelman School of Medicine, and colleagues wrote.1
Desir and colleagues performed a retrospective chart review of patients with cicatricial alopecia at the University of Pennsylvania between January 2019 and December 2023. They queried electronic health records by ICD-10-CM code for adults with central centrifugal cicatricial alopecia (CCCA; L66.8), lichen planopilaris (LPP; L66.1), and frontal fibrosing alopecia (FFA; L66.9) and verified diagnoses using provider documentation.
There were 2040 total cases of cicatricial alopecia cases, of which the investigators randomly analyzing 10% of cases from each subtype to obtain a representative s ample. Each distinct scalp sign or symptom was documented once per patient, with individuals possibly reporting multiple signs or symptoms during the study period. Categorical variables were analyzed using Fisher’s exact test.
The investigators found that of 204 cicatricial alopecia cases analyzed, 106 were CCCA and 98 were LPP or FFA. Patients with CCCA had a mean age of 46.64 years (standard deviation [SD], 14.11) compared with 59.03 years (SD, 13.10) in the LPP/FFA group. The CCCA group was 100% female and the LPP/FFA group was 93% female and 7% male. The CCCA group was 93% Black and the LPP/FFA group was 70.4% White and 15% Black.
Desir and colleagues found significant differing trends in symptoms between subgroups, with 28% of the CCCA group reporting pain, tenderness, or soreness compared with 13% of the LPP/FFA group (P <.01). On the other hand, 15% of the LPP/FFA group reported scalp erythema compared with 2% of the CCCA group (P <.01). The LPP/FFA group was also more likely to be asymptomatic (24% vs. 7%, P <.01). There were no differences seen in reports of itch (P = .89), or burning, tingling, or another dysesthesia (P = .58) between subtypes.
The investigators noted that limitations of the retrospective study included small sample size and missing data.
“While erythema is less often associated with CCCA compared to LPP/FFA1, erythema may be underappreciated in darker skin tones underscoring the need for improved diagnostic tools and awareness in diverse populations. Future research should prioritize larger, prospective studies to further clarify symptom patterns, particularly in ambiguous cases (such as indistinguishable CCCA versus LPP). Integrating symptom-based assessments into clinical practice and therapeutic trials can enhance treatment monitoring, optimize management strategies, and ultimately improve outcomes for patients with cicatricial alopecias,” Desir and colleagues wrote.1
Other recent research into cicatricial alopecia presented at last month’s 2025 American Academy of Dermatology (AAD) Annual Meeting suggest improved glycemic control could help patients with central centrifugal cicatricial alopecia (CCCA) lessen the burden of their disease.2
A retrospective cohort study led by a team from Johns Hopkins School of Medicine, results of the study demonstrate those maintaining an HbA1c level less than 5.7% were 5 times more likely to experience improvement in scalp fibrosis as their counterparts with an HBA1c in the diabetes or prediabetes range.
In multivariable-adjusted analyses, controlling for age, diabetes medication, and BMI, results indicated elevated HbA1c was significantly associated with scalp fibrosis (Odds Ratio, 5.67; 95% CI, 1.40 to 22.95; P = .02), with no significant associations found for pruritus, pain, or inflammation.2
REFERENCES
Desir N, Encarnacion I, Ogunleye TA, Taylor SC. Scalp Symptoms May Offer Diagnostic Clue for Cicatricial Alopecia Subtype. JAAD INT. Published online April 4, 2025. doi.org/10.1016/j.jdin.2025.03.001
Chang S, Wyche J, Aguh C. Elevated Hemoglobin A1C Levels Associated with Increased Scalp Resistance in Central Centrifugal Cicatricial Alopecia. Presented at the 2025 American Academy of Dermatology (ADA) Annual Meeting. Orlando, FL. March 07-11, 2025.
