Raechele Cochran Gathers, MD While people of all races and ethnicities suffer from hair loss, there is one particular type of serious and permanent hair loss that is seen overwhelmingly in African American women, and women of African ancestry. It is called Central Centrifugal Cicatricial Alopecia, or CCCA. CCCA hair loss is the most common form of permanent hair loss found in African American women.
What is CCCA?
CCCA is a hair loss disease. It slowly and quietly injures hair follicles—so slowly, in fact, that many women don’t even notice the subtle early hair loss signs of CCCA. Stylists are often the first to notice that a person is suffering from CCCA, and by the time a stylist starts to notice the tell-tale bald patches of CCCA, the disease has already progressed!
CCCA stands for Central Centrifugal Cicatricial Alopecia. Let’s break the name down:
- Central – center of the head
- Centrifugal – moving away from the center
- Cicatricial – scarring
- Alopecia – hair loss
What it Looks Like
In CCCA, a small patch of hair loss starts at the center of the scalp. Untreated, this bald patch grows slowly outwards, in a circular fashion, until eventually there is a large bald circular patch, usually involving the entire top of the head. In CCCA, the hair doesn’t just fall out of the follicle, like in some types of alopecia. Instead, the follicle is completely destroyed, and replaced by scar tissue.
Causes
In past years, some scientists thought that CCCA was caused by using a hot comb and hot grease on the scalp. In fact, they used to call the condition ‘hot comb alopecia.’ That hypothesis was debunked a number of years ago, though. The exact cause of CCCA has not been definitively proven, but it is likely caused, in part, by chronic inflammation on the scalp. There is good evidence to suggest that this inflammation may be caused by chronic tension, traction and pulling on the scalp.
Sew-in weaves, and braided hair with extensions, especially if they are tight and cause discomfort when installed, seem to be associated with CCCA. There is also some evidence that CCCA might have a genetic component, with some individuals being more susceptible to it. There may also be genetic factors. Fibroids have also been linked to CCCA.
Warning Signs
When untreated, people with CCCA will eventually develop a large area of hair loss at the top of the crown. But there are early warning signs to look out for. It’s important to know the warning signs of CCCA hair loss. Hair loss might start with hardly noticeable signs, like hair that grows slower or breaks off easily at the crown. Left unchecked, this hair loss can worsen, causing an increasing area of baldness that can eventually be permanent.
What to Look For
- Itch at the top of the head
- Tenderness at the top of the head
- Hair at the top of the head that seems to grow much more slowly
- Hair at the top of the head that breaks easily
- Inflammation or redness on the scalp
- Thinning at the top of the scalp
Prevention
CCCA seems to be caused by chronic inflammation on the scalp. There is good evidence to show that hairstyles that are tight, and cause discomfort—like a tight sew-in or braids—can be associated with inflammation and the development of CCCA in susceptible individuals. Knowing this, one should avoid hairstyles that cause any level of discomfort. It’s not normal to have to ‘get used’ to your hairstyle. It shouldn’t take a few days for your new sew-in or crochet braids to feel comfortable. If your hairstyle causes you discomfort, that is your body’s way of letting you know that it is causing inflammation and damage.
CCCA Treatments
If you’re having any scalp or hair issues, it is important to first see a board certified dermatologist so that you can be examined. Your dermatologist may treat you with a number of medications that help to decrease the inflammation that is damaging your hair follicles and help with hair regrowth.
- Topical steroids
- Injected steroids
- Oral anti-inflammatory medications
- Calcineurin inhibitors
- Minoxidil
Conclusion
If you think that you may be suffering from CCCA or another hair or scalp condition, don’t panic. And don’t ignore it. You need to be proactive. Visit a board certified dermatologist so that you can get an accurate diagnosis and determine a treatment plan for the hair loss. In addition to seeing a board certified dermatologist, you can also look at organizations such as the Cicatricial Alopecia Research Foundation for helpful resources and information on hair loss support groups in your area.
