What is Central Centrifugal Cicatricial Alopecia?

Central Centrifugal Cicatricial Alopecia (CCCA) is a form of scarring alopecia, which starts in the center of the scalp. CCCA is most common in women of African descent, but it can also affect men and women of any ethnicity.

What does Central Centrifugal Cicatricial Alopecia look like?

In CCCA hair tends to start falling out in the middle of the scalp. Hair loss then gradually spreads out from that point. Often, people with CCCA notice hair being more brittle and breaking more easily. Other symptoms include itching, pain or tenderness of the scalp, a spongy texture to the scalp, and flaking or redness of the affected areas.

How is Central Centrifugal Cicatricial Alopecia diagnosed?

Your doctor will use your medical history, examine your scalp and often take a scalp biopsy, from an area at the edge of the patch of hair loss, to diagnose CCCA. Doctors may also take a skin swab to rule out an infection of the scalp.

Is Central Centrifugal Cicatricial Alopecia permanent?

The hair loss caused by CCCA is permanent, but treatment can help to slow down or stop any more hair loss from happening.

What causes Central Centrifugal Cicatricial Alopecia?

The exact cause of CCCA is unknown, but it has often been linked to hair styling practices, which include: heat (hot combs/hair straighteners, hair dryers and curling irons); traction (tight braids/cornrows, weaves, tight ponytails or hair extensions that pull on the hair); and use of chemical relaxers (especially lye relaxers).

More recently, changes in a gene called PADI3 have been linked with development of the condition in about 25% of cases. Several studies have also reported an association of type 2 diabetes with hair loss, and potentially with CCCA.

Can Central Centrifugal Cicatricial Alopecia be treated?

The hair loss caused by CCCA cannot regrow, but there are ways of slowing down and potentially stopping more hair loss from happening.  Usually, your doctor will prescribe topical or injected corticosteroids, which help to dampen down the inflammation. Other treatments include tetracyline (an antibiotic), ciclosporin (a drug that slows down the immune attack on the hair follicles) or hydroxychloroquine (an anti-malaria drug that also helps to suppress the immune system). People with CCCA are also recommended to use natural hair styles.

Additional Information:

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

Click here to visit the BAD Patient Information Leaflet on CCCA

The Australasian College of Dermatologists have some helpful facts about CCCA:


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