Increased Prevalence of Antinuclear Antibody Positivity in Central Centrifugal Cicatricial Alopecia Patients

Introduction: Central centrifugal cicatricial alopecia (CCCA) is a primary scarring alopecia predominantly affecting black women. Autoimmune mechanisms, including antinuclear antibody (ANA) positivity, have been hypothesized to contribute to its pathogenesis but remain underexplored. Method: Using the TriNetX database (2004-2024), we identified black women with CCCA and controls with other primary scarring alopecias. Patients were propensity score matched by current age and age at diagnosis. We compared the prevalence of ANA positivity and autoimmune comorbidities before and after alopecia diagnosis. Statistical significance was defined as an adjusted p value <0.05. Results: Among 5,811 CCCA patients and matched controls, CCCA patients were more likely to have positive ANA (11.8% vs. 2.0%, p < 0.001) and systemic lupus erythematosus (SLE) post-diagnosis (0.9% vs. 0.3%, p = 0.007). They were less likely to have type 1 diabetes pre-diagnosis (2.9% vs. 4.8%, p = 0.007) and post-diagnosis (0.8% vs. 1.3%, p = 0.024). No significant differences were found in other autoimmune diseases. Conclusion: CCCA patients had higher prevalence of ANA positivity and SLE, supporting potential autoimmune involvement. However, screening for other autoimmune diseases in asymptomatic CCCA patients may not be necessary. Further research is needed to clarify the interplay between autoimmune and metabolic pathways in CCCA.