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Central Centrifugal Alopecia

Central Centrifugal Alopecia (CCA) – Also sometimes referred to as
Central Centrifugal Cicatricial Alopecia (CCCA) or
Central Centrifugal Scarring Alopecia (CCSA)

What is Central Centrifugal Cicatrical Alopecia (CCA)?

This is a hair loss condition that frequently starts in the middle of the top of the scalp and gradually spreads outwards. An inflammatory process is present that destroys hair follicles and replaces them with fibrosis and scar tissue. CCA is one of the most common hair loss conditions in African American women.

What is the cause of Central Centrifugal Cicatrical Alopecia (CCA)?

While the cause of Central Centrifugal Cicatrical Alopecia is not known, many grooming and styling techniques such as hair weaves, extensions, chemical relaxers, and bonding glue are felt to potentially aggravate the problem.

What are the symptoms?

Women suffering from Central Centrifugal Cicatrical Alopecia experience hair thinning in the central part of the scalp. Over time, the hair loss progressively worsens and causes scarring of the hair follicles. Some ladies report that the scalp is itchy, sore, and tender or feels like a burning sensation in the affected areas. The result of this inflammation and scarring and  hair loss.

How is it diagnosed?

The scalp is examined by a dermatologist to look for signs of inflammation, hair loss, and scarring. Based upon these findings a skin biopsy is performed to make a specific diagnosis. will analyze the scalp biopsy. Next, they will examine the hair follicles under the microscope to determine if it is indeed CCCA.

What tests are needed?

A doctor’s visit will include a blood tests as well as a scalp biopsy.

What is the expected duration?

After the inflammatory process starts, it can continue for many years. Many individuals wait 5 or 10 years to see if the hair will grow back on its own before seeking medical treatment. This prolonged period of waiting before medical evaluation allows the condition to spread more extensively and larger areas of baldness occur. Once the follicle has been destroyed or scarred, this cannot be undone

How can it be prevented?

There is no way known to prevent CCA. Although not proven, avoiding hair weaves, bonding glue, hair extensions, chemical relaxers, gels, and other harmful chemicals are beneficial to the scalp and hair, this condition can also occur in individuals who wear a natural hair style and never use chemicals. There is a belief that going natural can reverse the baldness and hair loss that occurs, so some ladies try this before seeking medical evaluation but the hair loss can continue to progress.


Currently, treatments for CCA include doxycycline, hydroxchloroquine, topical and injectable steroids, and other immunomodulators such as topical tacrolimus.

Early research suggests that Platelet Rich Plasma (PRP) can help with symptomatic improvement and some hair growth when done before the scarring process is complete

Hair transplant surgery can be considered for some cases once the inflammation has completely stopped.

When to contact a professional

A dermatologist specializing in hair loss should be contacted as early as possible when hair thinning progressively worsens with or without itching, pain or irritation.


As effective treatment is still in the testing phase, many patients consult with their trained hair professional to utilize such options as wigs or hair extensions.

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