Central Centrifugal Cicatricial Alopecia in Black Women: Diagnostic Challenges and Molecular Insights.

Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia that disproportionately affects Black women but remains underrecognized and frequently misdiagnosed because of its clinical overlap with other forms of hair loss. Emerging research has expanded the understanding of CCCA beyond its clinical presentation, highlighting the potential contribution of genetic susceptibility and disruptions in fibroinflammatory and metabolic pathways. A comprehensive literature review of publications from 2015 to 2025 identified 15 primary studies, supplemented by relevant reviews and case reports, addressing diagnostic features and evolving perspectives on disease pathogenesis. CCCA typically presents as progressive thinning of the central scalp and may resemble androgenetic alopecia or alopecia areata. Dermoscopy and histopathology remain important for accurate diagnosis, with findings that may include follicular dropout, perifollicular fibrosis, and lymphocytic inflammation. Molecular investigations have identified several pathways of interest, including those involving peptidyl arginine deiminase 3 (PADI3) and peroxisome proliferator-activated receptor gamma (PPAR-γ); however, their precise clinical significance continues to be investigated. Associations with autoimmune and metabolic comorbidities further support a multifactorial disease process involving genetic, inflammatory, and metabolic influences. Underrecognition may delay treatment and contribute to worse outcomes. Greater clinician awareness, culturally informed diagnostic approaches, and continued investigation of molecular mechanisms may support earlier detection, more individualized treatment, and reduced health disparities among women of color.