Systemic Comorbidities in Central Centrifugal Cicatricial Alopecia: A Systematic Review and Meta-analysis

Central centrifugal cicatricial alopecia (CCCA) is the most common scarring alopecia among women of African descent and has been increasingly associated with systemic comorbidities, particularly cardiometabolic and fibroproliferative conditions. We conducted a PRISMA 2020 compliant systematic review and random-effects meta-analysis, prospectively registered in PROSPERO (CRD420250656067), to quantify pooled prevalence estimates and case-control associations for comorbidities in CCCA. MEDLINE and Embase were searched through 18 June 2025 for observational studies reporting comorbidities in CCCA. Twenty three studies, comprising 9,103 patients with CCCA, were eligible. Hypertension (51.9%, 95% CI 33.8-69.6), dyslipidemia (58.4%, 95% CI 29.0 82.8), obesity (37.1%, 95% CI 10.8-74.2) and uterine leiomyomas (28.0%, 95% CI 8.0-64.0) were frequently reported, with substantial heterogeneity across studies. In case-control analyses, CCCA was significantly associated with dyslipidaemia (OR 4.46, 95% CI 1.09-18.25), uterine leiomyomas (OR 2.25, 95% CI 1.10-4.58) and anxiety disorders (OR 3.27, 95% CI 1.22-8.79), whereas hypertension, obesity and thyroid disease were not consistently associated. Most included studies were retrospective and predominantly U.S.-based, contributing to methodological heterogeneity. These findings suggest that CCCA may be accompanied by a substantial burden of medically recorded systemic comorbidities and support holistic, individualized clinical assessment.