What Is Central Centrifugal Cicatricial Alopecia (CCCA)?

Central centrifugal cicatricial alopecia (CCCA) is a type of scarring alopecia (hair loss) that causes patches of hair loss that start on the top of the head and spread outward. It is a common type of hair loss in middle-aged Black women. It's unclear why this rare hair loss pattern occurs. Some evidence suggests that inflammation of the hair follicles at the top of your head might be the cause.

Learn more about CCCA, including signs and symptoms and how to treat and prevent this condition.

What is Central Centrifugal Cicatricial Alopecia (CCCA)?

Central centrifugal cicatricial alopecia is a type of hair loss that primarily impacts Black women and may run in families. CCCA typically causes hair breakage, itching, and scaling of the scalp. You might stop hair loss by taking anti-inflammatory medications and using minoxidil, a topical hair regrowth treatment.

Some forms of alopecia do not get a lot of attention, such as CCCA, which is relatively rare in the general population. However, this type of alopecia is prevalent among middle-aged Black women with curled or kinked hair, impacting between 2% and 7% of this group.

CCCA Symptoms

Hair breakage is one of the first signs of CCCA. It's unclear why baldness from CCCA starts from the top of the head. This rare hair loss pattern typically occurs where inflammation occurs, which may be at the top of the head.

Other symptoms that affect your scalp include:

• Bumps, crusting, and scaling
• Burning and stinging
• Itching
• Pain
• Patches of hair loss, which usually start at the top of your head and spread outward
• A pins-and-needles feeling 
• Shiny, smooth scalp where hair loss occurs
• Tender scalp

There's a lack of public awareness surrounding the condition. Many people simply are not sure what CCCA symptoms mean, so they might not know to get treatment.

"Many patients with CCCA don't know what the cause of their hair loss is or wait a while to see if it resolves on its own before seeking medical treatment. Not much of the public is aware of what it is," Angelo Landriscina, MD, a dermatologist based in New York, told Health. "This is unfortunate because once the hair has gone, it most likely will not come back even with treatment."

What Causes CCCA?

CCCA damages your hair follicles, or the openings that your hair grows from. That damage results in scarring, which often causes permanent hair loss.

The exact cause of CCCA is unknown. Some evidence suggests that abnormal inflammation around the hair follicles might cause hair loss. Using chemical relaxers, hair weaves, and hot combs might worsen inflammation and damage to the hair. Still, those hair care practices do not directly cause CCCA. Research also indicates that this condition may be hereditary.

CCCA Risk Factors

CCCA is most common in Black women. It's unknown exactly how many Black women have CCCA due to a lack of research. The scarcity of studies highlights the health disparities in the field of dermatology for Black women, said Dr. Landriscina.

"[CCCA] wasn't well understood or well-studied, likely due to a lack of Black dermatologists and also the fact that Black communities are underserved when it comes to dermatology," said Dr. Landriscina. "Conditions like [CCCA] really expose the effects of racism in medicine."

Other risk factors include:

• Age: This type of alopecia most commonly affects middle-aged people.
• Genetics: CCCA often runs in families. Research has identified a potential gene, PADI3, that seems to be mutated in some people with CCCA.
• Illnesses: Inflammation from other health conditions, such as autoimmune disorders, diabetes, and heart disease, might affect your scalp.
  

How Is CCCA Diagnosed?

A dermatologist can typically diagnose CCCA by examining your scalp. They'll likely ask questions about your hair loss, including when you noticed it and whether you have other symptoms. A dermatologist might ask about how you style and take care of your hair.

They might perform a scalp biopsy, taking a small skin sample from your scalp. A dermatologist will then send the sample to a lab for evaluation, which confirms CCCA.

Because of the nature of scarring alopecia, it's important that anyone who thinks they're experiencing hair loss checks in with a dermatologist as soon as possible: "Remember, time is hair," said Dr. Landriscina.

Treatments for CCCA

Hair loss is often permanent with CCCA. The goal of treatment is to stop hair loss and maintain the hair you have left. A dermatologist may recommend therapies that help reduce inflammation of the scalp.

Treatments might include:

• Dandruff shampoo: This helps reduce scaling on your scalp.
• Gentle hair care practices: This includes natural styling (i.e., chemical and heat-free), reducing the use of relaxers, and limiting styling products to prevent inflammation and hair damage.
• Minoxidil: People commonly use this over-the-counter (OTC) topical solution to treat male-pattern hair loss. Minoxidil might help stimulate hair growth from follicles that are not scarred from CCCA. You must take a medication that gets rid of inflammation, along with Minoxidil, to stop hair loss.
• Oral anti-inflammatory medications: You might take doxycycline, which is most commonly used to treat bacterial infections, Andrew Alexis, MD, MPH, vice-chair for diversity and inclusion for the department of dermatology at Weill Cornell Medical College, told Health.
• Steroids: These include topical medications and scalp injections that reduce inflammation. Steroids like triamcinolone are often injected into the affected areas.
  

How to Prevent CCCA

While CCCA can't be prevented entirely, you can prevent the condition from spreading by getting treatment at the first signs of hair loss. If you start treatment before scarring occurs, you may be able to reverse some hair loss as well. In contrast, hair loss is likely permanent with a late diagnosis.

Living With CCCA

Hair loss can significantly impact your emotional and mental health. You might feel embarrassed by or self-conscious of your hair loss. Research has found that CCCA lowers self-esteem and increases the risk of anxiety and depression. Seek out mental health support from a therapist, friends, and family, as needed.

Here are some ways to care for your hair and help you cope with CCCA:

• Apply a broad-spectrum, water-resistant sunscreen with an SPF of at least 30 to parts of your scalp affected by hair loss.
• Avoid relaxers and other chemical irritants.
• Do not choose hairstyles that pull on your scalp (e.g., a weave, hair extensions, and tight braids). Brush your hair gently.
• Limit the use of dry heat on your scalp.
• Look for support groups.
• Protect the hair you have by following your medical provider's guidance.
• Shampoo your hair once per week.
• Take medications as a dermatologist prescribes.
• Talk to a dermatologist before trying home remedies for hair loss and ways to cover up hair loss. They might suggest powder or a wig.
• Wear a wide-brimmed hat while outdoors to avoid sunburns on your scalp.