What is Central Centrifugal Cicatricial Alopecia (CCCA)?

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40% Black Women Have Central Centrifugal Cicatricial Alopecia

Did you know? According to the American Academy of Dermatology (AAD), almost half of black American women suffer from hair breakage and hair loss at the top or crown of our heads. This is one of the main symptoms of a form of alopecia called Central Centrifugal Cicatricial Alopecia CCCA.

Unfortunately, we don’t usually find out we have this complicated form of alopecia until it becomes obvious that something is wrong. Hair is all over the pillow, in the shower and on the floor – everywhere but on the scalp!

Although 40.9% of African American women have hair loss consistent with a CCCA diagnosis, only 8.8% of us are officially diagnosed, according to Dr. Yolanda Lenzy of the AAD.

If you are experiencing hair loss or breakage at the top of your head, and the rest of your head seems okay, please see a dermatologist right away.

What Does “Central Centrifugal Cicatricial Alopecia” Mean?

Let’s break this down. Here’s what CCCA stands for:

  1. Central. This refers to the vertex of the head, i.e., the crown. As long as the alopecia has started somewhere on the top of the head, it might be CCCA.
  2. Centrifugal. When it starts spanning out (as it will, if you can’t stop it), CCCA spans out in the same shape as the original balding spot.
  3. Cicatricial means this kind of alopecia scars the scalp.
  4. Alopecia means hair loss.

In short, CCCA is hair loss at the top of the head that spreads and leaves scarring, after which the hair never grows back.  There is usually dramatic hair  breakage in the same area before it falls out. At the breakage stage is when a doctor should still be able to help you avoid permanent hair loss.

What Are the Stages of CCCA?

CCCA hair loss is said to be permanent once it gets to a certain stage. According to a Vancouver dermatologist, Dr. Jeff Donovan, who deals specifically with different forms of alopecia, this is how CCCA starts and progresses:

Initial stages of CCCA

  1. Toxic Sebum Production. For reasons scientists aren’t sure about, the sebaceous glands of the hair follicles start producing less sebum. This sebum is also toxic to the hair follicle, and instead of nourishing the hair follicle and easing the growth of the hair, it causes inflammation.
  2. Hair Follicle Inflammation. This occurs under the scalp. Hair growth will slow, because the hair cannot grow out easily when there isn’t enough sebum. The hair is also being choked by inflammation.
  3. Hair Growth And Sebum Production Ceases. Inflammation eventually makes it impossible for the hair to grow. The stem cells inside the hair follicle that are responsible for hair growth are destroyed by inflammation.The hair and scalp will start feeling extremely dry, too, because the swelling also kills the sebaceous glands in the follicle.

Under so much distress, the hair follicles begin to release hair. For most people, once the hair falls, there is little or no hope for it to grow again from the same follicle. They’ve entered late-stage CCCA.

Late stages of CCCA

  1. Follicle Death. After releasing the hair, the follicle starts to close up and die.
  2. Scarring. After the follicle dies from CCCA, scarring occurs, completing the process.

CCCA Is Similar to an Allergic Reaction

Scientists do not know what causes CCCA exactly. But to make it a little easier to understand how we get CCCA, let’s compare it to an allergic reaction.

The widespread use of chemicals in the west has spiked the occurrence of allergies. With allergic reactions, there is usually some form of swelling or inflammation. If you have allergies, you already know that when you eat something you are allergic to, your body produces histamines that cause swelling.

In a like manner, faulty sebum causes internal swelling of the hair follicle, like an allergic reaction would. The swelling eventually kills hair follicles, spreads and kills more.

So what makes your scalp behave like it is allergic or sensitive to something you’re doing or putting on it? Because most of the time, that’s exactly what’s happened.

What Triggers CCCA? (And How You Can Avoid This Alopecia)

If you wish to avoid CCCA and permanent hair loss, stop engaging in anything that will cause your hair follicles to become irritated or distressed. The triggers of CCCA tend to be:

  • Pulling the hair tightly,
  • And harsh chemical use.

“Everyone who utilizes these styling practices should do so infrequently and for short periods of time,” says Dr. Lenzy. of the AAD.

Why Does CCCA Affect Black Women So Much?

In short, we are doing the opposite of Dr. Lenzy’s advice. We are utilizing tight styles, like weaves and braids, and harsh chemicals, such as relaxers, frequently and for long periods of time! Genetics are a possibility for CCCA, of course, but rarely contributes to this particular form of alopecia. Well, it might if you consider that people of African descent tend to scar easily.

Whatever the case, this condition is almost completely restricted to black women. CCCA was originally referred to as “hot comb alopecia.” When it was discovered in 1968, it was thought that the hot, petroleum-based hair grease that was heated on the hair while hot combing caused inflammation of the hair follicles and hair loss.

Hot comb usage has decreased. But CCCA is endemic: It pretty much only affects us and it is very, very widespread in our communities, according to Dr. Lenzy.

We increase our risk of CCCA developing because we are constantly pulling and irritating our hair follicles with:

  • Tight cornrows, braids, extensions and weaves
  • Relaxers, jheri curls and texturizers
  • Hair dyes
  • Tight rollers
  • Blow drying with tight pulling

We even combine these methods to get the look we’re after. You could probably add to this list after thinking of the many times you’ve been told, “Pain is beauty.” (Long sigh.) Eventually, pain is baldness.

Other Practices That Can Contribute to CCCA

The home use of professional salon products without proper education can also highly irritate the hair follicles. This is because the chemicals in salon stylers and other products are typically concentrated. Many of them are supposed to be diluted in the salon.

But sometimes, stylists achieve quicker and smoother results on black hair by not diluting these products, or otherwise not using them as directed. What happens if the consumer observes this practice in the salon, thinking it to be correct? A lot of women head out to buy the professional grade product themselves and continue the practice at home. This is a big mistake.

It is also interesting to note that stylists are trained to begin chemically processing hair at the crown, in order to avoid damage to the edges of the hair, which are much weaker than the hair up top, which tends to be healthier (i.e., more kinky and hard to color/curl/straighten, at least in the beginning).

The chemicals from relaxers, jheri curls, hair dyes, and setting lotions, are left on the hair for longer periods of time at the top and crown of the head as compared to other areas. Could this be the reason that the inflammation of CCCA starts at the top of the head? It’s food for thought.

How Can You Tell For Sure Your Hair Loss Is CCCA?

You won’t be able to tell if it is CCCA for sure without going to a dermatologist. A biopsy needs to be performed to diagnose CCCA, because the inflammation is usually not visible on the surface of the scalp.

Remember, CCCA begins in the top or crown of the head. A biopsy will show:

  • Destruction of the sebaceous glands
  • Inflammation
  • A missing inner root sheath in the hair follicle
  • Missing stem cells
  • Destruction of hair follicles
  • Hair miniaturization – hairs with a thinner diameter

How Will a Dermatologist Treat Scarring Alopecias Like CCCA?

It really depends what stage of scarring alopecia your hair follicles are in.

What can be done in early-stage CCCA

A good dermatologist will go after CCCA aggressively in order to stop its spread. That usually includes more than one form of medication, and you might receive a topical cream, oral medication and even shots in the scalp to prevent inflammation and hair loss.

Your dermatologist will try to:

  • Reduce the inflammation of your hair follicles with anti-inflammatory medication.
  • Control any other issues happening on your scalp, like infections, that could aggravate the inflammation. So you may be prescribed antibiotic or antifungal medication.
  • Stimulate your follicles to produce hair using prescriptions like minoxidil (the primary medicine in Rogaine).
  • Normalize your scalp help weak hair follicles regenerate with medication like topical steroids.

Is there anything that can be done in late-stage CCCA?

There is nothing that can be done in late-stage CCCA. Recall that with scarring or cicatricial alopecia, the hair follicles die, and scar tissue forms.

At this point, you might be offered a hair transplant – the moving of healthy follicles from one part of the scalp to another.

Also keep in mind, though, that your entire head won’t be in the same phase at the same time. The original spots where the CCCA balding began will scar over first. But you still might be taking a host of medication to halt CCCA from spreading.

Are There Natural Treatments For Central Centrifugal Cicatricial Alopecia?

Yes, scarring or (cicatricial) alopecias like CCCA can be treated naturally.

If you’ve been diagnosed by a dermatologist and are now thinking about going to a naturopath for treatment? Here is what you can expect during your CCCA alopecia treatments:

A New Cleansing Regimen

You’ll typically start off with deep cleansing that uses ingredients that decrease inflammation and are antibacterial and antifungal. You may get a mix of some or all of the following as a scalp cleansing mask:

  • Clay powder – deep cleansing
  • Activated charcoal powder – deep cleansing
  • Tea tree oil – antibacterial and antifungal
  • Ginger root juice – cleansing, improves circulation and encourages hair growth. Don’t worry, ginger doesn’t typically burn the scalp.
  • Diluted black soap – an all natural soap and more gentle and nourishing cleanser
  • Aloe vera juice – moisturizing to the hair and scalp to help prevent dry scalp and hair breakage. Also alkalizes the scalp to encourage hair growth

Organic Oils

You will also receive one, or a mixture, of the following oils.

  • Castor oil or Jamaican black castor oil for scalp clarification, and follicle and growth support. Both unrefined and black castor oils are anti inflammatory. They are also analgesic, meaning they soothes pain and itching.
  • Rosehip (rosa mosqueta) seed oil, shea butter and pure argan oil are all anti-scarring oils. They are used in skincare formulas to remove and prevent scarring.
  • Jojoba oil – This oil is structured very similarly to the scalps natural sebum. Sebum is important to healthy hair follicles and healthy hair in general, but CCCA makes sebum toxic then destroys the sebaceous glands. Jojoba oil is used in natural formulas to dilute the toxic sebum, so that CCCA inflammation and hair breakage are lessened.
  • Peppermint essential oil – calms scalp and encourages growth.

You might  be given a hair growth formula that contains oils with similar properties. The naturopath will ensure, however, that the product is free of chemicals, including synthetic fragrances. This root stimulator is an excellent example:

Root Recovery Hair and Scalp Treatment - DHT Blocker, Hair Growth Serum, Hair Loss Treatment, All Natural, Saw Palmetto, Man or Woman



You may also be asked to use a home microneedling device. Microneedling is used to spark collagen renewal in the skin. It can increase circulation to the scalp in order to nourish hair follicles better, decrease inflammation, aid hair growth and help prevent follicle death and scarring.

Microneedling is used after applying organic oils. This treatment helps the oils penetrate the scalp skin deeper. The 0.5 mm size doesn’t hurt when pressed gently on the scalp, and it can be used weekly or monthly.

Dia 540 Micro Needles Skin Care Titanium Microneedle Derma Roller Needle-k2


Should I Choose Traditional or Natural Medicine?

The choice of traditional or natural medicine largely depends on:

  • Your Lifestyle. Both natural and traditional medicines have regimens that require your commitment. Natural medicine can be more rigorous than traditional medicine.
  • Your Preference. Some people think naturopaths are quacks. Others are plain allergic to traditional doctors. Try to keep an open mind, in case you need to switch later.

Because the exact cause of CCCA is unknown, neither traditional nor natural therapies are guaranteed to work on every individual, says research published by the Department of Dermatology and Cutaneous Surgery at the University of Miami.

Don’t Mix and Match Treatments

It is not advisable to use natural oils in the same area as a steroidal or minoxidil cream, unless approved by your dermatologist. This is because natural oils and substances are powerful in themselves. You don’t want to go overboard and cause another problem!

So don’t mix and match, okay? Seek professional advice, and go with one method or other. If traditional medicine doesn’t work for you, visit a naturopathic doctor, taking your lab results with you. A good naturopathic physician might even tell you to stick with traditional medicine or advise you how to use traditional and naturopathic methods together.

If CCCA is eating up your hair, take a moment to make a commitment to yourself to get your hair and scalp in order. If you need to, throw on a hat or head wrap when you go out to reduce your stress levels. Then go to a dermatologist or naturopath, and do what you need to do to stop CCCA.

Hopefully you will get a lot of hair back in the process.

Do you have central centrifugal cicatricial alopecia (CCCA)? Although half of black women have the symptoms of CCCA, it is under-diagnosed and under-treated. Please help us spread the word! Tell us what is working for you and what isn’t in the comments. And share this article on social media.

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