Central Centrifugal Cicatricial Alopecia

Understanding CCCA

Central Centrifugal Cicatricial Alopecia, or CCCA, is a form of scarring hair loss in which inflammation damages the hair follicles and they are progressively replaced by scar tissue.

Hair loss typically begins around the central or crown area of the scalp and gradually extends outwards.

Because the follicular damage can become permanent, identifying and controlling active disease as early as possible is important.

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Who Is Affected by CCCA?

CCCA predominantly affects women of African descent and is one of the most important causes of permanent hair loss within this group.

It can, however, occasionally occur in other patients.

Historically, CCCA was sometimes attributed primarily to particular hair-care practices. Current understanding is more complex: the exact cause remains uncertain and is likely to involve several factors, including genetic susceptibility and inflammatory processes. Hair-care practices that create tension, heat, chemical exposure or scalp irritation may contribute in some individuals, but should not be presented as the sole cause.

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Signs and Symptoms of CCCA

CCCA often begins gradually.

Possible features include:

• Thinning at the crown or centre of the scalp
• Progressive outward spread of hair loss
• Hair breakage
• Reduced hair density
• Scalp tenderness
• Itching
• Burning or discomfort
• Areas where follicular openings become less visible

Some patients have relatively few scalp symptoms despite progressive hair loss.

Because early CCCA can sometimes resemble other types of hair loss, detailed assessment can be important.

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Early Recognition Matters

Where follicles have already been destroyed and replaced by scar tissue, the resulting hair loss is permanent.

The priority in active CCCA is therefore usually to identify the condition early, control inflammation and preserve follicles that have not yet been permanently damaged.

Waiting until a large area has become visibly smooth or scarred can significantly limit future restoration options.

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Assessment at YT Medical

Assessment may include:

• Examination of the pattern of loss
• Discussion of symptoms
• Review of hair-care practices
• Medical and family history
• Digital trichoscopy
• Assessment for evidence of follicular inflammation or scarring

Where CCCA is suspected, further specialist medical assessment may be recommended.

A scalp biopsy can sometimes be required to help confirm the diagnosis and distinguish CCCA from other forms of scarring alopecia.

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Hair and Scalp Care

Reducing unnecessary trauma to already vulnerable follicles can form an important part of management.

Current BAD guidance advises avoiding or reducing practices that create excessive tension, chemical irritation, friction or heat where possible. This may include tight braids, extensions, weaves, frequent relaxer use and excessive heat styling.

This advice should always be approached sensitively and individually, particularly because hairstyle choices may have personal, cultural, religious or professional importance. BAD specifically recognises these considerations within its CCCA guidance.

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Hair Restoration Options

The first objective is to establish whether the condition is active and preserve remaining viable follicles.

Where hair loss is permanent, patients may also wish to discuss cosmetic and restorative options.

Hair replacement can provide an immediate non-surgical solution.

Hair transplantation may be considered in carefully selected patients whose CCCA has been appropriately controlled and stable, although scarring alopecia can make transplantation less predictable than transplantation for conventional pattern hair loss.