Central centrifugal cicatricial alopecia (CCCA) is a type of hair loss that occurs in people with tightly coiled or textured hair. It is also known as hot comb alopecia, follicular degeneration syndrome, or central centrifugal scarring alopecia. This condition is more common in women of African descent but can affect people of all races and genders. CCCA is a progressive and permanent hair loss condition that can cause significant psychological distress.


Causes and Risk Factors

The exact cause of CCCA is unknown, but it is believed to be multifactorial. Genetics, hairstyling practices, and scalp inflammation are all thought to contribute to the development of CCCA. People with a family history of hair loss, autoimmune disorders, or inflammatory scalp conditions may be at increased risk of developing CCCA. Hairstyling practices that involve pulling the hair tightly, such as braids, weaves, and cornrows, can cause physical trauma to the hair follicles and lead to CCCA.


CCCA typically starts at the crown of the head and spreads in a centrifugal (or outward) pattern. The affected areas may appear shiny and smooth, with little to no hair growth. Hair loss may also occur along the hairline, in the nape of the neck, or in other areas of the scalp. People with CCCA may experience itching, burning, or tenderness in the affected areas. These symptoms can be exacerbated by certain hairstyles or scalp products.


Diagnosing CCCA can be challenging because the symptoms can be similar to those of other types of hair loss. A dermatologist or hair specialist will typically perform a physical exam of the scalp and hair and may take a scalp biopsy to confirm the diagnosis. A scalp biopsy involves removing a small sample of scalp tissue and examining it under a microscope. The biopsy can help to rule out other causes of hair loss and confirm the presence of scarring and inflammation in the hair follicles.


Unfortunately, there is no cure for CCCA, and the hair loss is typically permanent. However, there are several treatment options that can help to slow or stop the progression of the condition and improve the appearance of the scalp.

  1. Medications: Topical or oral medications may be prescribed to reduce inflammation and promote hair growth. Corticosteroids, immunosuppressants, and minox(idil) are commonly used for CCCA treatment.
  2. Lifestyle modifications: People with CCCA should avoid hairstyles that pull the hair tightly and use gentle hair care products. Avoiding heat styling tools and protecting the hair from the sun can also help to reduce damage to the hair.
  3. Hair transplantation: Hair transplantation is a surgical procedure that involves taking hair follicles from one part of the scalp and transplanting them to the affected areas. This procedure can be effective in restoring hair growth but is typically only recommended for people with stable disease who are not experiencing active inflammation.
  4. Wigs or hairpieces: Wigs or hairpieces can be used to cover areas of hair loss and improve the appearance of the scalp. A skilled hair stylist can create a natural-looking wig or hairpiece that matches the person’s hair color and texture.

Hair loss can be a distressing experience, and it is not uncommon for people to experience depression or anxiety as a result. It is important to seek help if you are struggling with depression or anxiety caused by hair loss. Talk to your doctor or a mental health professional about your symptoms and feelings. It may also be helpful to reach out to a support group or connect with others who have experienced hair loss. Remember that you are not alone, and there is help available.