Central centrifugal cicatricial alopecia (CCCA) is a scarring hair loss condition that predominantly affects Black women. Multiple causes are often in play, and there’s no known cure. But treatments can help slow or even stop progression of CCCA, which is why early intervention is so important.
Discover what central centrifugal cicatricial alopecia (CCCA) is, why it predominantly affects Black women, and how to recognise its symptoms. This article covers diagnosis, available treatments and ways to slow the progression of CCCA.
Key takeaways
CCCA is a scarring alopecia, so hair loss can become permanent and irreversible if the condition is left untreated.
There’s no single cause of CCCA; genetic factors, inflammation, scalp health and certain styling practices can all contribute to its development or progression.
CCCA predominantly affects Black women, particularly those in their 30s, 40s and 50s. Symptoms include hair loss starting at the crown, scalp irritation, burning, tenderness and skin changes.
There’s no known cure for CCCA, but treatments such as corticosteroids, minoxidil, JAK inhibitors and antibiotics may help manage inflammation and slow progression.
Central centrifugal cicatricial alopecia is a type of scarring alopecia, which means that the follicles can become damaged and scarred by scar tissue as the condition progresses. When this happens, the follicle stops producing hair permanently — so if you suspect you might have CCCA, it’s essential to get a diagnosis and treatment early.
It hasn’t yet been established exactly what causes CCCA, so there’s no single underlying cause to treat [1]. Inflammation of the hair follicles is a key marker of CCCA, but it’s thought to be triggered by a combination of genetic, environmental, and personal factors, including:
While some of these factors are in your control, others aren’t. Adapting your styling choices can help stop hair loss worsening, but if you’re genetically predisposed to develop CCCA, it won’t prevent or reverse the condition.
CCCA almost exclusively affects Black women, especially those in their 30s, 40s and 50s [8]. Research suggests up to 5.6% of Black women may be affected by CCCA, making this one of the most common types of alopecia in Black women [8].
That said, CCCA can occasionally affect men and women of other ethnicities. Children can also be affected by CCCA.
Studies suggest that CCCA can be hereditary, with at least one case report detailing a mother and a daughter with CCCA [4-6].
Research has shown that mutations in the PADI3 gene may play a role in the development of CCCA. The PADI3 gene is responsible for modifying some of the proteins involved in hair growth.
However, the genetic role isn’t quite that simple. Other genes may also be involved, especially in severe or extensive cases [9]. So symptoms of CCCA may vary depending on which genes are involved — and without individual assessment, it’s not possible to know which specific factors are responsible for your CCCA symptoms.
No, central centrifugal cicatricial alopecia isn’t contagious. It’s not possible to spread it to others, though any underlying scalp infections may be contagious, depending on the cause.
The most common symptoms of central centrifugal cicatricial alopecia include [1]:
CCCA is a scarring condition which means the affected follicles are gradually replaced by scar tissue. This can make the skin in areas of hair loss appear smooth and shiny.
The symptoms above can help diagnose central centrifugal cicatricial alopecia. But because some of these symptoms resemble other conditions too, it’s always best to get a clinical diagnosis from a qualified trichologist.
In addition to the above, a trichologist can check for [1, 10]:
These indicators can differentiate CCCA from other similar conditions like traction alopecia and female pattern hair loss.
There’s no known cure for CCCA, and no treatments have yet been licensed to treat this condition. But it’s possible to slow the progression of CCCA, so current treatments focus on reducing inflammation and other symptoms. Here are some of the treatments that can help reduce the severity of CCCA.
Corticosteroids are sometimes prescribed for treating CCCA. Steroid creams for hair loss can reduce inflammation around the follicles, reducing symptoms like irritation, burning, and scalp tenderness.
If steroid creams don’t work, you may be prescribed an oral steroid or steroid injection. Long-term steroid use generally isn’t advised for hair loss, as it can cause skin thinning and other side effects.
Topical minoxidil is often used as a first-line treatment for CCCA, despite limited clinical evidence to support its use for this condition [2]. Minoxidil dilates the blood vessels in the scalp, which can promote hair growth by providing more nutrients and oxygen to the hair follicles via the blood supply.
In CCCA cases, the follicles are often permanently damaged from scar tissue. Minoxidil is unlikely to help in cases where there’s extensive permanent damage. However, because it’s an over-the-counter treatment, many people with CCCA decide it’s worth trying minoxidil.
Where minoxidil works in CCCA cases, researchers have attributed the success to stimulating hair growth in follicles that haven’t yet been affected by scarring, and helping to minimise the impact of androgenetic alopecia where it coexists alongside CCCA [2].
JAK inhibitors including tofacitinib, baricitinib, and brepocitinib have been shown to help reduce symptoms of CCCA by reducing inflammation, although larger studies are needed to show their effectiveness at scale [11-12].
Tetracyclines are antibiotics that reduce inflammation as well as fighting bacterial infections, making them suitable treatments for CCCA in some cases. The most commonly used tetracycline for CCCA is doxycycline, which can offer modest benefits for CCCA patients [2].
Tetracyclines are usually offered as a second-line treatment if steroid creams haven’t worked. They can cause side effects like nausea and diarrhoea, so patients may decide to discontinue use if the adverse effects outweigh the benefits.
Studies suggest protective hairstyles may aggravate CCCA and make the condition progress more quickly [13]. So if you regularly wear your hair in tight protective styles, or you tend to wear heavy wigs or weaves, you’ll probably be advised to avoid these.
Ketoconazole shampoo is sometimes recommended as a CCCA treatment, due to its anti-inflammatory properties [2]. While it’s mainly used as an antifungal for seborrheic dermatitis and similar fungal conditions, it can also be used to treat non-fungal inflammatory scalp conditions like CCCA.
Finasteride, a drug normally used by men to treat male pattern baldness and benign prostate enlargement, is also sometimes prescribed as a treatment for CCCA [2]. However, finasteride isn’t usually recommended for premenopausal women, as it can disrupt the menstrual cycle and interfere with foetal development.
Hair transplants aren’t usually suitable for treating CCCA. The condition is unpredictable, and can affect transplanted hairs as well as native hairs. That means your long-term results may be compromised by CCCA, so most reputable surgeons won’t recommend FUE or FUT surgery for CCCA patients unless your condition is very stable.
Yes — with the right treatment plan, it is possible to stop CCCA from progressing and causing further hair loss. However, because CCCA is a condition with multiple potential causes, and not all treatments are suitable for all patients, finding the right treatment can be tricky.
Professional hair loss advice is critical to controlling the progression of CCCA. With regular check-ins, treatment assessments, and progress updates, you may be able to stop CCCA getting worse.
No, CCCA isn’t reversible. CCCA causes scar tissue to form over the follicles, causing permanent, irreversible hair loss. That’s why early treatment is best — the sooner you stop CCCA from progressing, the more hair you can retain.
If you’re losing hair and you suspect it might be CCCA, it’s best to get prompt professional advice. A qualified trichologist can help you create a treatment plan that works for you, helping limit CCCA progression so you can keep as much hair intact as possible.
The Wimpole Clinic is an award-winning hair transplant clinic with more than 50 years’ experience of treating hair loss. Our qualified trichologists are on hand to provide empathetic professional advice to anyone experiencing hair loss, giving you a reliable diagnosis and clear treatment plan to help reduce your symptoms.
We have clinic locations nationwide, so it’s easy to access the hair loss treatment you need. Book a consultation at your nearest Wimpole Clinic location to schedule your hair loss assessment.
Find out more about central centrifugal cicatricial alopecia in these frequently asked questions.
No, there’s currently no known cure for central centrifugal cicatricial alopecia. Treatments are designed to slow progression of the condition, but there’s no way to completely cure it yet.
Follicular degeneration syndrome is a former name for the condition now known as central centrifugal cicatricial alopecia [14]. The name ‘follicular degeneration syndrome’ was proposed when researchers observed abnormal shedding of the inner root sheath of the hair follicles in patients with this type of hair loss.
Hot comb alopecia is a former name for the condition now known as central centrifugal cicatricial alopecia [14-15]. CCCA was known as ‘hot comb alopecia’ because early researchers linked it with using a hot comb and the application of hot petroleum to the crown to straighten the hair. However, the link between this practice and CCCA has been questioned over the years.
It’s not possible to get rid of CCCA, as it’s a progressive condition with no known cure. However, you can slow or even stop the condition getting worse with steroid treatment, JAK inhibitors, minoxidil, and other proven treatments.
Whether hair can grow back after CCCA depends on the extent of the scarring. If scar tissue has permanently damaged the follicles, the hair won’t grow back. However, where hair has fallen out but the follicles are still intact, it may be possible for hair to regrow.
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Dr Laila Ahmad (GMC: 6134794) graduated from the University of Newcastle in 2006 with a Bachelor of Medicine and Bachelor of Surgery (MBBS). She completed her postgraduate training in General Practice in 2013 and is a Member of the Royal College of General Practitioners (MRCGP).
Throughout her medical career, Dr Ahmad has gained broad clinical experience across a range of surgical specialties within the NHS, including general surgery, breast surgery, ear, nose and throat (ENT), and obstetrics and gynaecology. Her work in several hospitals across the North East of England has provided her with a strong surgical foundation and a comprehensive understanding of patient care.
Following her general practice qualification, Dr Ahmad undertook advanced training in hair restoration surgery under the mentorship of pioneering hair transplant surgeon Mr Michael May at the prestigious Wimpole Clinic on Harley Street. She has also trained alongside leading hair restoration surgeon Dr Ahmad Moussa, a neurosurgeon with extensive expertise in complex hair restoration procedures.
As a result of this rigorous and specialist training, Dr Ahmad has developed significant expertise in advanced hair restoration techniques. She is proficient in performing follicular unit extraction (FUE) and eyebrow restoration procedures, applying meticulous precision and refined technical skill to each case.
In clinical practice, she manages a wide spectrum of complex hair restoration cases. Her approach integrates scientific methodology and detailed surgical planning with an appreciation for aesthetic balance, ensuring results that are both technically precise and naturally harmonious.
With a strong artistic sensibility, Dr Ahmad is particularly skilled in designing natural hairlines and eyebrow patterns tailored to each individual patient. She maintains a patient-centred ethos, delivering hair restoration procedures to the highest clinical standards while prioritising safety, personalised care, and optimal aesthetic outcomes.
