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August 2016

A Probable Case of Central Centrifugal Cicatricial Alopecia Encountered in Mark Twain’s Autobiography

Author Affiliations
  • 1Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
  • 2Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
JAMA Dermatol. 2016;152(8):927. doi:10.1001/jamadermatol.2015.5635

In Mark Twain’s autobiography, he describes visiting his uncle’s farmhouse in 1847 Missouri where an elderly African American slave woman, “Aunt Hannah,” lived.1 She had “a round bald place on the crown of her head” and every summer for 5 or 6 years the children “used to creep around and gaze at it in reverent silence.”1 Aunt Hannah’s alopecia is most likely central centrifugal cicatricial alopecia (CCCA) based on the pattern, distribution, demographics, and the demonstrated irreversibility over at least 5 or 6 years.