Central centrifugal cicatricial alopecia (CCCA) is a type of hair loss. This hair loss, called alopecia, usually begins at the crown, or top center, of the head. It then spreads outward in a roughly circular pattern, which is what centrifugal means. If it is not treated, it can cause scarring that damages the hair follicles, which is what cicatricial means. That is why it is important to find a treatment plan that works for you.

According to StatPearls, CCCA is most common in women of African descent, but people of all races and genders can develop it. It may run in some families. If you’ve been diagnosed with central centrifugal cicatricial alopecia, here’s what you need to know so you can have informed conversations with your healthcare providers about your treatment plan and needs.

Causes of CCCA

CCCA is associated with inflammation on the scalp around the hair follicles. Over time, this damages, then destroys, the hair follicles. These are the small openings in your scalp where your individual hairs come out. When hair follicles are destroyed, scar tissue develops in their place. Once you have scar tissue, you will most likely have permanent hair loss in that area.

No one knows exactly what causes CCCA. It may be connected to problems with your immune system, to diseases that cause inflammation in other areas of your body, or to your genetic and family history. However, researchers need to do more work to figure out which of these play a part and how they lead to CCCA.

There’s a common belief that CCCA is caused by certain hairstyles, hair grooming practices, or styling products, but this has not been proved. Many people who don’t wear the styles or use the practices and products in question have developed CCCA anyway. How you do your hair or the products you use on it may contribute to scalp inflammation in some way, but researchers need to do more work to know if this is true. Most research suggests that a number of factors come together to cause CCCA.

Signs and Symptoms of CCCA

Hair loss starting at the crown (central scalp) and moving outward is the most obvious sign of CCCA, but it’s not always the only sign or the first sign that you’ll see. Other symptoms of CCCA that may come before or after hair loss include:

• Uncomfortable scalp sensations — These include itching, burning, pain, tenderness, or stinging. These sensations may be bad enough to interfere with your daily life.
• Hair breaking off — More hair than usual in your brush might be due to hair breakage. If this happens mostly at the center of your scalp, it might be CCCA.
• Scalp changes — Some people notice small bumps on their scalp, while others report the skin there feeling scaly or like it has a crust on it.

After you lose your hair, you might notice that the affected areas become smoother or shinier than you remember. This happens when those hair follicles have scarred over. This makes CCCA a type of scarring alopecia, which is different from some other types of alopecia that don’t leave scars, like alopecia areata or traction alopecia. Scarring makes it harder to effectively treat CCCA, so it’s important to catch it early and choose a treatment option as soon as you can.

Conditions Related to CCCA

Some early research suggests that CCCA may be linked to certain infections or autoimmune conditions. Researchers have also explored a possible connection between CCCA and type 2 diabetes. In addition, CCCA may be more common in people who have uterine fibroids or high LDL (“bad”) cholesterol. However, scientists still need to do more research to better understand whether these conditions are truly connected to CCCA and how they may be related.

Diagnosing CCCA

To diagnose CCCA, someone from your dermatology team will likely start by asking you what symptoms you have noticed. This gives you a chance to share any concerns about your scalp, including any symptoms of CCCA but also including anything else you’ve experienced in the past or are experiencing now.

After that, your healthcare provider will examine your scalp. This allows them to look for signs of CCCA. It may also allow them to rule out any other scalp problems that could cause the symptoms you’re experiencing.

Many dermatologists will do a scalp biopsy to confirm CCCA and see if there’s any scarring. They’ll use local anesthetic to numb an area where you’re losing hair, then take a sample of skin so they can look for inflammation, scarring, and the condition of the hair follicle. This procedure is performed quickly in the doctor’s office.

Treating CCCA

When it comes to finding the right treatment for CCCA, you and your doctor will usually talk about your treatment goals first. These usually include:

• Slowing down hair loss or stopping it altogether
• Helping your hair grow back when that’s possible
• Relieving other symptoms, which usually means reducing inflammation

It’s important to remember that you may not be able to stop CCCA entirely or regrow all of the hair you’ve lost in areas that have already scarred over. This doesn’t mean you can’t make progress, though. Your dermatologist can tell you what you can expect to see and how long it should take to achieve those goals.

Treatment for CCCA may involve several different medications. These may be taken orally, injected, or applied topically to your scalp, depending on the medication and your needs. Medications may include:

• Corticosteroids — These can be applied topically or injected, and they work to fight inflammation.
• Antibiotics — These are used because they are anti-inflammatory, not because you have an infection. You’ll generally take these as pills for between two and six months.
• Calcineurin inhibitors — These medications that reduce immune activity in the skin are applied topically. They also fight inflammation.
• Hair regrowth medications — These aren’t used alone, but your doctor may prescribe this topical or oral treatment to help your hair grow back.

Your doctor may also give you instructions about how to care for your hair or products and practices to avoid. They may tell you to avoid styles that put a lot of pressure on your scalp, like weaves or tight braids. Some doctors may have you avoid any practice that could lead to inflammation, like heat close to your scalp or chemicals that could irritate it. Hair care items like chemical relaxers, for instance, can cause irritation in some people. If certain hairstyles or processes are important to you, talk to your doctor about the best way to use them while minimizing scalp damage.

Follow up with your dermatologist regularly. They can make sure your CCCA is under control, help you find additional treatments if you need them, and come up with creative ways to cover any thinning areas on your scalp.

Practical Hair Care Tips for CCCA

In general, gentler hair-care practices will help reduce inflammation on your scalp. This might mean some of the things mentioned above, like not pulling excessively on your scalp or choosing hair products that don’t involve harsh chemicals or heat.

If you want to use heat styling or chemical treatments, try spacing them out more than you usually would. This can help reduce inflammation on your scalp, even if it doesn’t eliminate it. You may also be able to find substitutes for products like shampoo and conditioner that will help your scalp, rather than risk further damage.

Seeking Help for CCCA

If you have any of the scalp issues noted above, see a dermatologist even if you haven’t noticed an area of hair loss yet. You might be able to catch CCCA early and get the help you need before you lose any (or any more) hair. If you’re losing hair and the thinning starts at the crown and spreads outward, see a dermatologist. They may be able to get you on a treatment plan that will slow or stop your hair loss.

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