Prior studies have turned up mixed results when it comes to confirming whether or not patients with the scarring alopecia central centrifugal cicatricial alopecia (CCCA) are at increased risk for diabetes. Some studies, including the 2019 study by Coogan et al and the 2011 study by Kyei et al, have suggested there is a link and some studies have suggested there is no link at all.
Roche et al, 2022
Roche and colleagues set out to investigate whether patients with CCCA are are increased risk of diabetes compared to women without CCCA. To do so, the authors retrospectively evaluated Black women between the ages of 18 and 74 years who presented to the Hospital of the University of Pennsylvania from April 13, 2016, to April 13, 2020, were examined. They compared the rates of diabetes in those with CCCA and the rates of diabetes in those who did not have a diagnosis of CCCA.
Risk of Diabetes Increased in Women with CCCA
During the 4-year study period, the authors retrieved records of 39,280 Black women. There were 395 women with a medical diagnosis of CCCA of which 201 women had a biopsy confirmation of the diagnosis.
Of the 16,454 women without CCCA, 43% (7002 of 16,454) had a medical diagnosis of type 2 diabetes. Of the 181 women with a clinical diagnosis CCCA, 58% of whom (105) had a medical diagnosis of type 2 diabetes. This was felt to be statistically significant. (Odds ratio 1.86 with confidence interval 1.39 – 2.51, p<0.001).
However, when authors looked specifically at cases of biopsy confirmed CCCA, they could not find this association and in fact women with CCCA seemed to be a lower risk of diabetes. 26 % of women with biopsy proven CCCA had diabetes compared to 43 % of women without CCCA. (Odds ratio 0.48 with confidence interval 0.29-0.78, p<0.05)
Controlling for Obesity Suggests Risk of Diabetes in CCCA
After controlling for obesity (choosing BMI less than 30), women with CCCA were more likely to have a diagnosis of type 2 diabetes. Specifically, 37% of women with CCCA had a history of type 2 diabetes compared with 12% of controls (odds ratio, 4.13; 95% confidence interval, 2.76-6.18; P<0.05)
Conclusions and Comments
This is an interesting study and fuels the ongoing debate about the risk of diabetes in CCCA. The authors conclude that nonobese women with CCCA are at four times greater risk for type 2 diabetes than women without CCCA.
The authors controlled for one of the risk factors in their statistical model – namely weight. It would be nice to review the data according to other risk factors too including cholesterol and blood pressure and age. We know that women with low HDL are at increased risk for diabetes. Does the risk of diabetes remain when weight and cholesterol and age are controlled for ? The same is true for high blood pressure. Women with blood pressure measurements over 140/90 mmHg are at increased risk for type 2 diabetes. Does the risk of diabetes remain when weight and cholesterol and age and blood pressure are controlled for ?
All in all, this is an interesting study which uses a large data base to answer some important questions. The risk of diabetes may be increased in those with CCCA and screening for diabetes is certainly important in those with CCCA.
Roche FC et al. Association of type 2 diabetes with central centrifugal cicatricial alopecia: A follow-up study. J Am Acad Dermatol. 2022 Mar;86(3):661-662.
Samrao A. Evaluating the association of central centrifugal cicatricial alopecia (CCCA) and fibroproliferative disorder. Dermatol Online J 2021; Aug 15; 27(8).
Coogan PF et al. Association of type 2 iabetes with central-scalp hair loss in a large cohort study of African American women. .Int J Womens Dermatol. 2019 Jun 6;5(4):261-266.
Kyei et al. Medical and environmental risk factors for the development of central centrifugal cicatricial alopecia: a population study..Arch Dermatol. 2011 Aug;147(8):909-14.