In this MD Newsline exclusive interview with dermatologist Dr. Victoria Barbosa, we discuss disparities in diagnosing and treating central centrifugal cicatricial alopecia (CCCA) before and during the COVID-19 pandemic.
What disparities in diagnosing and treating CCCA have you observed in your clinical practice?
Dr. Victoria Barbosa:
“Recent research has shown us that CCCA has a significant genetic component. So, the fact that CCCA is more common in Black women is not a disparity because that’s not preventable. That’s genetic. However, what I do see in clinical practice is a significant delay in diagnosing and treating CCCA.
So, what does that mean? Well, it means that sometimes patients see two, three, or four doctors before they even receive a diagnosis of CCCA. This sometimes happens because hair loss gets poo-pooed, ‘oh, it’s just hair loss. We have to worry about your hypertension and your diabetes.’ So, sometimes, the hair loss that is very important to the patient doesn’t seem as important to the physician or healthcare provider that’s treating the patient. And that’s a shame.
Sometimes, it’s because the provider is not aware of CCCA and just isn’t able to make an accurate diagnosis in time to treat the patient. And sometimes, it’s because the provider erroneously believes nothing can be done to treat scarring alopecia, and they’ll tell that to their patients, but that’s just not true.
First, we can try to prevent the progression of CCCA, which we can often do by slowing or stopping the disease from progressing. Second, sometimes, we’re able to achieve some hair regrowth, and that’s because we don’t go from active follicle to complete fibrosis overnight. There’s a point where the follicles stop producing hair before complete fibrosis occurs, and if we catch that point in time, we can get those follicles working again.
So, it’s really important to be aggressive and not dismissive in treating CCCA so that we can keep the hair that a patient’s got and do our level best to bring some back. And the truth is that sometimes that works, and sometimes it doesn’t, but I believe that everybody deserves a try.”
Do you think these disparities have worsened during the COVID-19 pandemic?
Dr. Victoria Barbosa:
“The disparities in diagnosing and treating CCCA have absolutely worsened during the COVID-19 pandemic. I believe these disparities are due to two factors. First, for a long time, patients were nervous about venturing out of the house, especially to go to a doctor’s office.
Also, we know that brown and Black people have been subject to worse COVID-19 outcomes in terms of morbidity and mortality. So, the very people who need to be seen for CCCA are the very people who are at higher risk of worse COVID-19 outcomes.
Second, we’ve seen more hair loss than ever these last couple of years due to the pandemic. People who have had COVID-19 often end up with a different form of hair loss from the illness called telogen effluvium. And, for some people, the mere stress of the pandemic has also caused telogen effluvium.
Telogen effluvium is very different from CCCA. It is characterized by a sudden rapid loss of telogen hairs with no damage to the follicles. But, it’s very disconcerting for patients because it happens so suddenly, and it can be quite traumatic. And so, because we’re seeing so many people with COVID-19-related hair loss, the underlying CCCA sometimes gets missed.
So, those are two ways that the pandemic has contributed to the disparities in diagnosing and treating CCCA.”
Responses have been condensed and lightly edited.