Central Centrifugal Cicatricial Alopecia in a Fair Phototype Patient

Abstract

Clinical examination showed decreased hair density on the vertex without significant hair loss patches [Figure 1]. Trichoscopy showed a diffuse loss of follicular openings with patches of perifollicular erythema. Hair shaft variability with vellus hairs was observed, and moderate peripilar casts were present. It also revealed a notable peripilar white halo and a honeycomb pigmented network on the interfollicular area [Figure 2a and b]. A 4‐mm punch biopsy was performed. Histological examination showed a mild perifollicular lymphocytic inflammation at the level of the upper isthmus and concentric fibrosis with an absent inner root sheath. Compound follicles with fusion of the outer root sheaths (ORSs) were present [“Google‐like” structures, Figure 3]. The diagnosis of central centrifugal cicatricial alopecia (CCCA) Grade II‐B was established.[1]