Lesion Without Pain, Pain Without Certainty: A Critical Reappraisal of the NeuPSIG Diagnostic Algorithm for Neuropathic Pain.

Central centrifugal cicatricial alopecia is often viewed as a scalp-limited disorder causing permanent hair loss, mainly in women of African descent. This study shows that many affected patients also have other health conditions, particularly high blood pressure, diabetes, abnormal blood lipids, uterine fibroids and anxiety. Some of these conditions appear more common than in people without CCCA. Recognizing these links may help clinicians look beyond the scalp and identify important health risks earlier. A broader, more holistic approach to patient care could therefore improve overall health outcomes in this population. Central centrifugal cicatricial alopecia (CCCA) is a primary lymphocytic cicatricial alopecia and the most common cause of permanent hair loss among women of African descent (–). Although historically described in middle-aged women, CCCA may present at younger ages and is frequently underdiagnosed in its early stages, when irreversible follicular damage may already be established (, ). Clinically, it is characterized by progressive centrifugal hair loss originating at the vertex, often accompanied by inflammatory symptoms such as pruritus or scalp tenderness (). Pathogenetically, CCCA shares features with other primary lymphocytic cicatricial alopecias, including immune-mediated damage to the hair follicle bulge region and subsequent fibroproliferative remodeling (, ). Earlier models emphasized the role of traumatic hair practices (), but accumulating evidence supports a multifactorial process involving genetic susceptibility, immune dysregulation and aberrant fibrotic pathways (–). Recent molecular studies further suggest that CCCA may display a distinct profile characterized by altered lipid metabolism and mitochondrial stress responses (–). These findings reinforce the concept that CCCA is not solely a localized scarring disorder but may reflect broader biological perturbations.