Say this five times fast: Central Centrifugal Cicatricial Alopecia (CCCA). It may be hard to pronounce, but it's even harder to diagnose. That's partly because there are a lot of causes of alopecia (hair loss). And it's partly because CCCA affects Black women almost exclusively. "Like many conditions that affect people of color, it's understudied," says Nada Elbuluk (M.D. 2009).
"Only 3% of dermatologists are Black," says Elbuluk. Because of that shortage, some Black patients may be deterred from seeing a dermatologist for fear that a physician may not understand skin of color, she says. It's also a primary reason she decided to go into dermatology.
She first discovered her passion for skin of color as a medical student, when she had the opportunity to connect with Black physicians in Detroit who were serving as mentors to U-M medical students. She believes dermatology students need to be exposed to a diverse array of skin tones while they are training.
Elbuluk notes that not only do some conditions, like CCCA, affect Black people at higher rates, but also common conditions can present differently depending on the patient's skin tone. "Eczema in a dark-skinned person might look more purplish and brown rather than red," she says.
She is a dermatologist at the University of Southern California, where she founded the Skin of Color and Pigmentary Disorders Program and now runs its clinic.
It was in the clinic that she met Julie Wright, who had been experiencing hair loss for years and hadn't been able to get any answers. "I see this on a weekly basis in my clinic, individuals of color who have conditions that have been misdiagnosed or never diagnosed," says Elbuluk.
Elbuluk examined Wright and got a detailed hair history, including her hair care routine, what products she was using, how often she washed her hair, her family's history of hair loss, medications she was taking, and more. Elbuluk also did a biopsy.
"There are some hair loss conditions that can be diagnosed clinically, but with scarring alopecias, it's important to do a biopsy, because there are others outside of CCCA," says Elbuluk. It's also important to diagnose early to prevent further scarring.
After the exam, history, and biopsy, Elbuluk was able to diagnose Wright with CCCA. She began Wright on a thorough treatment plan, including topical and oral medications, as well as steroid injections into the scalp to help stop the progression of her condition and prevent it from spreading. Wright was able to get some hair growth back as well.
"It was very rewarding for me [to help her]," says Elbuluk, who received a Patient Care Hero award from the American Academy of Dermatology for this patient's treatment. "It was also a good experience for her to find a physician who specialized in skin conditions of color. That's really the goal of why I created the clinic and program — and why I do what I do."