What Is Central Centrifugal Cicatricial Alopecia?

The perception is that younger people experience scarring alopecia more than their parents did at the same age. That may be true, but the data is lacking.

Central Centrifugal Cicatricial Alopecia (CCCA), a form of hair loss that initially occurs on the vortex (crown) of the scalp before spreading outward, largely occurs in women of African descent (a small percentage of CCCA occurs in Caucasians and men). CCCA has historically been attributed to the use of harsh chemicals and tight braiding that are popular with women with this heritage.

This condition is considered a medical issue, initially requiring the attention of a physician or dermatologist for reasons explained below. If long-term damage occurs due to this condition, the treating physician may refer women to a hair loss solutions provider who specialize in cosmetic hair loss treatments for women.

According to a paper published in 2022 (“Central Centrifugal Cicatricial Alopecia,” by Sarah Garos and Sadia Masood, Rowan University and Aga Khan University Hospital, Karachi, StatPearls), “The cause of central centrifugal cicatricial alopecia is not clear … this concept was discarded upon recognition of the problem in women who were not using these various hair products. Literature suggested that environmental and genetic factors also play some role in the etiology … Current evidence does not support these various theories. The etiology of central centrifugal cicatricial alopecia is multifactorial. Various other suggested causes include infections, autoimmune disease, or genetic factors. It could be idiopathic, but still, more studies needed to clarify this concept.”

One theory cited in the paper is the CCCA might be due to a fibroproliferative disorder, or FPS. Consistent with this condition, FPS is characterized by persistent irritation and mild inflammation.

Nonetheless, it is a problem that the study found to be prevalent in three to six percent of women who have African ancestry, with the most like age of onset being 36 years of age. Symptoms that accompany the hair loss can include small, raised bumps on the scalp and a burning, stinging, or itchy sensations.

The condition does involve scarring of individual hair follicles, where the scars replace the hair and consequently hair loss is permanent. But the American Academy of Dermatology Association states that CCCA can be reversed or at least halted from spreading with early-onset treatment. The Academy further recommends that a board-certified dermatologist be consulted to identify and treat the problem.

Such a consultation is not entirely about the aesthetic nature of CCCA-caused hair loss. The doctor would look into the possibility that the hair loss is related to a thyroid condition, or nutrition deficiencies (for example, if the individual needs more iron).

When left untreated, CCCA can increase in the area of the scalp that is affected. This should provide sufficient incentive for a patient to seek medical advice and early treatment, as hair is a prominent part of any person’s identity.