Safety and Efficacy of Clobetasol Propionate 0.05% Emollient Foam for the Treatment of Central Centrifugal Cicatricial Alopecia

July 2020 | Volume 19 | Issue 7 | Original Article | 719 | Copyright © July 2020

Published online June 26, 2020

Valerie D. Callender MD,a Abrahem Kazemi MD,b Cherie M. Young MD,a Jeaneen A. Chappell MD,c Leonard C. Sperling MDd

aCallender Dermatology & Cosmetic Center, Glenn Dale, MD bDepartment of Dermatology, New York Medical College, New York, NY cSaint Louis University, St. Louis, MO dHCT Dermatopathology Services, Baltimore, MD

Background: There is currently an unmet need for the treatment of women with central centrifugal cicatricial alopecia (CCCA).
Objective: To evaluate the safety and efficacy of Clobetasol propionate 0.05% emollient foam for the treatment of women with CCCA.
Methods: Adult women of African descent that presented with clinical evidence of early CCCA were enrolled (N=30). Clobetasol propionate 0.05% emollient foam was applied daily in an open-label fashion. Safety and efficacy assessments were performed at weeks 2, 6, 12, and 14.
Results: Subjects achieved substantial improvements in pruritus, pain, tenderness, erythema and scaling. Scalp biopsies revealed considerable improvements in severe inflammation and perifollicular edema. Overall, clobetasol propionate 0.05% emollient foam was well-tolerated.
Limitations: This was a nonrandomized, open-label study. Enrollment was limited to subjects with clinically mild CCCA.
Conclusion: Subjects with CCCA that applied topical clobetasol propionate 0.05% emollient foam to their scalp daily demonstrated continuous clinical improvement throughout the 14-week study. Identifier: NCT01111981

J Drugs Dermatol. 2020;19(7): doi:10.36849/JDD.2020.5201


Central centrifugal cicatricial alopecia (CCCA) is a common cause of progressive, permanent, scarring alopecia. It is an inflammation-induced scarring type of hair loss that begins at the vertex of the scalp and progresses centrifugally. The etiology appears to be multifactorial. It occurs in all races but primarily among persons of African descent1 and with a much greater frequency among women.2,3 The prevalence is unknown, but may vary from 2.7% in South Africa to 5.6% in the United States within this population and increases with age.2,4

Pedigree analysis suggests an autosomal dominant mode of inheritance; however, hair grooming habits may markedly influence disease expression.5 Recently, a PADI3 gene mutation has been identified in patients with CCCA.6 The PADI3 gene is expressed in the inner root sheath, and encodes a protein that is necessary in the proper development of the hair shaft.6,7 Abnormal inner root sheath desquamation has been linked to the pathogenesis of CCCA.7 This finding may provide a causal relationship or increased susceptibility to hair loss in these individuals.6 Although an association between CCCA and the use of hair grooming styles that cause traction such as sewn-in hair weaving and cornrow or braided hairstyles has been reported,8,9 discontinuing these hair styles does not stop progressive hair loss. The results of a survey designed to determine risk factors for CCCA among African American women (N=326) revealed 59% had advanced central hair loss with clinical signs of scarring.10 Among those with CCCA, the incidence of bacterial scalp infections and diabetes mellitus type 2 were significantly higher as were hair styles associated with traction.10

Early diagnosis and treatment are essential in stopping or slowing the progression of scarring and permanent hair loss. Dermoscopy and histologic evaluation may reveal early or late findings that can help establish the diagnosis.11,12 Prompt and appropriate treatment is essential to help halt or slow disease progression.13 As the likelihood of scarring is related to the extent of inflammation, anti-inflammatory medications are the mainstay of treatment, with topical and intralesional corticosteroids being first-line treatments for CCCA.2,14–17 Other treatments include topical calcineurin inhibitors, oral antibiotics, hydroxychloroquine, and hair transplantation.1,2,14,15,18–20 In addition to a discussion on camouflage techniques, patients should be counseled to avoid physical and chemical trauma to the scalp.21