Central Centrifugal Cicatricial Alopecia Associated With PDL1 Loss and Increased Expression of Caspase 3: A Case Series

This case series investigates central centrifugal cicatricial alopecia (CCCA), a scarring alopecia affecting predominantly patients with skin of color, and its association with PDL1 loss and increased caspase 3 expression. The study highlights that approximately 30% of CCCA cases are linked to peptidyl arginine deiminase 3 misfolding mutations. The findings suggest that CCCA is a CD4-predominant T-cell process, and the observed loss of PDL1 along with increased caspase 3 expression indicates a potential involvement of the PD1/PDL1 pathway in the disease's progression. This research provides insights into the inflammatory mechanisms underlying CCCA, which typically results in progressive and permanent hair loss.