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In this MD Newsline exclusive interview with dermatologist Dr. Victoria Barbosa, we discuss Dr. Barbosa’s central centrifugal cicatricial alopecia (CCCA) treatment strategy. We also discuss the many rewards of treating CCCA.

MD Newsline:

What is your treatment strategy for CCCA?

Dr. Victoria Barbosa:

“I have a two-pronged approach to treating CCCA.

First, we have to address the inflammation that causes the follicle damage. So, I will use either an antibiotic like doxycycline or another medication like hydroxychloroquine because these medications have anti-inflammatory properties. I usually prescribe these medications for a short period of time, along with topical steroids for a more extended period of time to manage the inflammation.

In some cases, I’ll also use intralesional Kenalog, but that is largely guided by the amount of scalp surface area involved because nobody really wants injections over their entire scalp. But we’re often able to control the inflammation with oral and topical medications alone.

The second prong of the approach is to encourage regrowth of the hair. And there are several treatment options for doing that. I usually use topical minoxidil 5% as a first-line treatment, but sometimes I’ll turn to oral medication as well.

It’s important to note that there are no medications that are specifically approved for CCCA, so, in most instances, we are using medications for an off-label indication.”

 

MD Newsline:

Is there anything else you would like to speak on that we have not already covered? 

Dr. Victoria Barbosa:

“For some dermatologists, treating alopecia is very frustrating, particularly when it’s scarring alopecia. But I have to tell you I find it incredibly rewarding. Many of our patients with CCCA have felt not heard by previous doctors, have been made to feel like their concerns were minor problems, and they have suffered tremendous blows to their self-esteem.

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So, they are so happy to have physicians who give the condition a name, tell them that there is treatment, give them hope that their disease progression can slow down if not be halted entirely, and can sometimes even bring hair back.

I think it’s really important to know that we’re providing dermatologic care and psychological care for patients who have been so marginalized by society and the healthcare system. So, treating these patients for CCCA is really an opportunity to restore their sense of self.

And one of the things I find is that even when we’re not able to achieve all of the results that our patients might hope for initially, the journey of being respected by the healthcare system by knowing that they’ve received the very best possible care, and the journey towards self-acceptance and restoring their self-esteem and self-image—which shouldn’t just be dependent on hair—is a journey that I can help them along, and I find it to be incredibly rewarding.”

 

Responses have been condensed and lightly edited.

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