Using disease symptomatology to guide treatment in patients with central centrifugal cicatricial alopecia: introduction of C-CAT scoring tool

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Background: Central centrifugal cicatricial alopecia (CCCA) is a progressive scarring alopecia. No disease activity scale exists, making assessment of therapeutic intervention difficult. Objective: This study introduces the CCCA Clinical Assessment Tool (C-CAT), a novel scale that quantifies symptom severity to facilitate tailored treatment and track disease progression. Methods: A retrospective review of patients with CCCA were assessed on degree of pruritus, erythema, pain, disease progression, and scalp resistance, each scored from 0-2, over the course of a minimum of six months of therapy. Results: Eighty-two patients were included. The average initial C-CAT score was 3.4, consistent with mild to moderate disease activity. After six months of treatment, 88% of patients had improvement in score, with 48% of all patients achieving remission. Intralesional kenalog injections and topical clobetasol were the most commonly used therapies. Patients required an average of 3.6 different treatments to achieve therapeutic response. Limitations: The subjective nature of some C-CAT components may lead to inter-rater variability. Conclusion: The C-CAT provides a structured, quantitative method to assess CCCA severity, which facilitates tracking of disease improvement for the majority of patients with targeted therapy. This tool promotes personalized, symptom-based treatment and supports clinicians and patients in understanding this complex condition.