Metabolic Associations of Central Centrifugal Cicatricial Alopecia: A Case-Control Study

Central centrifugal cicatricial alopecia (CCCA) is a primary scarring alopecia with unclear etiology. Emerging evidence suggests an association with metabolic dysregulation, including altered protein levels in affected scalp tissue and increased insulin resistance. This study investigated potential associations between CCCA and metabolic dysfunction using a large, multicenter database.

Using the TriNetX database, we analyzed 2,482 black women with CCCA and 2,482 propensity score-matched controls with other primary scarring alopecias (2004-2024). Metabolic disorders and laboratory values were compared (Benjamini-Hochberg-adjusted p < 0.0042).

CCCA patients showed no differences in incidence of type 2 diabetes (19.7% vs. 19.5%, p = 0.591), prediabetes (17.8% vs. 21.0%, p = 0.265), obesity (30.9% vs. 38.5%, p = 0.054), or metabolic syndrome (1.4% vs. 1.2%, p = 0.404) compared to controls. CCCA patients had lower hypertension incidence (39.7% vs. 49.5%, p < 0.0001), higher HDL (58.0 vs. 55.5 mg/dL, p = 0.0016), and lower triglyceride (96.4 vs. 106.3 mg/dL, p = 0.0001) values.

We found that CCCA was not associated with most metabolic disorders. Thus, metabolic screening in CCCA patients should be individualized based on history and review of systems. Future research exploring genetic, inflammatory, and autoimmune pathways in CCCA pathogenesis is needed.