What is Central Centrifugal Cicatricial Alopecia

What is Central Centrifugal Cicatricial Alopecia?

Central centrifugal cicatricial alopecia (CCCA), also known as hot comb alopecia or follicular degeneration syndrome, is a type of hair loss that primarily affects women of African descent. It is a scarring alopecia, which means that hair loss is permanent due to the destruction of hair follicles and replacement with scar tissue. CCCA is thought to be caused by a combination of genetic, environmental, and hair care practices.


Pathophysiology of CCCA

The pathophysiology of CCCA involves inflammation and destruction of hair follicles, leading to permanent hair loss. The exact mechanism by which this occurs is not fully understood, but it is thought to involve an abnormal immune response in susceptible individuals. Inflammation of hair follicles can lead to scarring and fibrosis, which eventually destroys the follicle and leads to permanent hair loss.

Risk Factors of CCCA

There are several risk factors associated with CCCA, including genetics, environmental factors, and hair care practices. Studies have shown that there is a strong familial association with CCCA, suggesting a genetic component to the disease. Environmental factors such as UV radiation and pollution may also contribute to the development of CCCA. However, the most significant risk factor is thought to be hair care practices such as chemical processing, heat styling, and tight hairstyles.

Chemical Processing and CCCA

Chemical processing, in particular, has been strongly associated with the development of CCCA. Hair relaxers, which are commonly used by African American women to straighten hair, have been implicated as a major risk factor for CCCA. The active ingredient in hair relaxers is usually sodium hydroxide or calcium hydroxide, which can cause damage to the hair shaft and hair follicle. The use of hair relaxers has been associated with an increased risk of hair breakage, hair loss, and scalp irritation, all of which may contribute to the development of CCCA.

Other Hair Care Practices and CCCA

In addition to chemical processing, other hair care practices may also contribute to the development of CCCA. Tight hairstyles such as braids, weaves, and extensions can cause traction alopecia, which is a form of hair loss caused by prolonged tension on the hair follicles. Traction alopecia can lead to inflammation and scarring of hair follicles, which may contribute to the development of CCCA. Heat styling, such as the use of flat irons or curling irons, can also cause damage to the hair shaft and hair follicles, leading to hair breakage and hair loss.

Symptoms and Diagnosis of CCCA

The symptoms of CCCA usually begin with a gradual thinning of hair in the central scalp area, which eventually leads to a bald spot. The hair loss may be accompanied by itching, burning, or tenderness of the scalp. Over time, the bald spot may expand and merge with other areas of hair loss, eventually leading to complete baldness in the affected area. The hair loss in CCCA is usually permanent, as the hair follicles are replaced with scar tissue.

Diagnosis of CCCA is typically made through a combination of clinical examination and scalp biopsy. A scalp biopsy involves removing a small piece of scalp tissue for microscopic examination. The biopsy can help to confirm the diagnosis of CCCA and rule out other causes of hair loss, such as alopecia areata or telogen effluvium.


Treatment of CCCA is challenging, as the hair loss is usually permanent. However, early intervention may help to slow or halt the progression of the disease. Topical and oral medications may be prescribed to reduce inflammation and prevent further scarring of hair follicles. Hair transplantation may be an option for some patients, although the success rate may be lower in patients with scarring alopecia. 


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