Central Centrifugal Cicatricial Alopecia (CCCA)

Last updated: 6 February 2026. Next review: 6 February 2027

What is central centrifugal cicatricial alopecia (CCCA)?

Central Centrifugal Cicatricial Alopecia (CCCA) is a type of scarring hair loss that begins at the centre of the scalp and gradually spreads outward. It is most common in women of African descent.

CCCA permanently damages hair follicles, making early diagnosis and treatment important.

What does CCCA look like?

Hair loss in CCCA typically starts at the crown of the scalp and spreads outward in a centrifugal (circle) pattern.

Common signs and symptoms include:

Hair that becomes brittle or breaks easily
Thinning hair at the centre of the scalp
Itching, pain, or tenderness in affected areas
Flaking, redness, or inflammation

Early recognition can help slow progression and protect remaining hair.

How is CCCA diagnosed?

Diagnosis is usually made by a dermatologist through:

Medical history review and scalp examination
Skin swabs to rule out infections. The dermatologist may want to take a small piece of skin (skin biopsy), usually from the edge of hair loss. This will then be analysed in a laboratory to confirm the diagnosis.

Accurate diagnosis is important because scarring alopecia requires early treatment to preserve hair.

What causes CCCA?

While the exact cause of CCCA is unknown, research shows that increased numbers of immune cells are found around the hair follicles in the affected skin of people with CCCA. These immune cells are thought to destroy the hair follicles, and scarring occurs in the area around the hair follicles. However, it is not fully understood why this happens. There are several factors which may contribute:

Genetic factors: Changes in the PADI3 gene are linked to CCCA in about 25% of cases. This gene is important for hair formation and structure.
Medical conditions: Studies suggest links with type 2 diabetes and fibroproliferative disorders (conditions where excessive connective tissue builds up).
Hair grooming practices such as hot combs, straighteners, dryers, curling irons, tight hairstyles and chemical relaxers; In the past these have been linked with CCCA, however research on this has not found a clear link.

More research is needed to understand how these factors may contribute to the development of CCCA.

Is CCCA permanent?

It is unlikely that hair will be able to regrow once the hair follicles have been destroyed. However, treatment can slow or halt further hair loss, helping to preserve the remaining hair.

Can CCCA be treated?

Currently, there is no treatment that can reverse hair loss from CCCA. Treatments focus on slowing progression by reducing immune system activity and protecting remaining hair follicles. Common options include:

Topical or injected corticosteroids
Antibiotics
Hydroxychloroquine
Topical calcineurin inhibitors
Protective hair care: Using natural hairstyles that reduce tension, heat, and chemical damage

Early intervention may improve outcomes, so it’s important to consult a dermatologist promptly if you notice symptoms.

Additional Information:

The British Association of Dermatologists have produced a patient information leaflet about Central Centrifugal Cicatricial Alopecia:

Read the BAD Patient Information Leaflet on CCCA

The Scarring Alopecia Foundation (based in the US) have some useful information about Central Centrifugal Cicatricial Alopecia:

VISIT THE SAF WEBSITE

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