Central Centrifugal Cicatricial Alopecia (CCCA)

Central Centrifugal Cicatricial Alopecia (CCCA) is a form of hair loss that may be gradual, without symptoms, and can go unnoticed for long periods. In other cases, hair loss is associated with severe itching, burning, and pain, and is rapidly progressive. Other names for this order include follicular degeneration syndrome and hot comb alopecia.


CCCA can initially have no symptoms, but can often present with itching, burning, tingling and pain followed by hair loss most noted at the vertex (crown) of the scalp. As the hair loss progresses, it radiates outwards. The inflammation and subsequent scarring leads to permanent hair loss.


The exact cause of CCCA is unclear. It is suspected that this condition may be related to chemical processing, heat, or chronic tension to the hair. Various hair-grooming techniques such as use of hot combs, heat, tight hairstyles, and chemical relaxers have been blamed for this condition. Genetics (family history) are also thought to contribute.


CCCA is slowly progressive and worsens with time and may ultimately lead to permanent scarring. Hair will not regrow once the follicle is destroyed. However, it may be possible to treat the surrounding follicles before they are destroyed, and for this reason, it is important to begin treatment as early as possible. The most important goal of treatment is to prevent further progression of hair loss, not to bring hair back.

The first step is to STOP ANY STYLING PRACTICE THAT MAY BE CAUSING OR CONTRIBUTING TO THE HAIR LOSS. Often, that means no hot combs, no tightly applied rollers or braids, blow-drying or relaxers for a period of time.

Other treatment options include:

  1. Topical, oral or injected steroids.
  2.  Oral antibiotics such as doxycycline can help to reduce inflammation.
  3.  Topical minoxidil (Rogaine) can be used to stimulate hair growth.
  4.  Hair transplantation is an option for those who have permanent hair loss and the inflammation has resolved.