A Complete Guide to Central Centrifugal Cicatricial Alopecia (CCCA): Understanding the Condition

Monali Sharma
Medically reviewed by
Dr. Kaushal

Review medical content on WOW Rx Pharmacy, so that accurate drug use information is easily accessible to everybody.
Dr. Akansha is a licensed Clinical Pharmacologist. She possesses remarkable knowledge in Pharmacovigilance, prescription analysis, drug information, and drug safety services. Additionally, she is a keen learner and an educator.

Last Updated:

Woman worried about hair loss

Central Centrifugal Cicatricial Alopecia (CCCA) is a type of scarring Alopecia. 

CCCA is also known as Follicular Degeneration Syndrome, Pseudopelade of the Central Scalp, or Hot Comb Alopecia.

The North American Hair Research Society coined the term CCCA in 2011 to refer to the characteristic pattern of hair loss.

It predominantly affects women of African descent but may affect men too.

In the research, Khumalo NP reported that CCCA is prevalent in 1.2% of women below 50 and 6.7% of women older than 50.

Although its emotional and psychological impact can be severe, it is a treatable condition.

Keep on reading to understand more about Central Centrifugal Cicatricial Alopecia.

What is CCCA

CCCA is a chronic and progressive type of scarring Alopecia. If not treated early, it may result in the permanent destruction of hair follicles.

What is scarring Alopecia?
Scarring Alopecia is a type of hair loss that causes permanent destruction of hair follicles. Usually, it results from inflammation, chemical burns, or Autoimmune disorders.

The name Central Centrifugal Cicatricial Alopecia refers to the progression of hair loss.

You start to lose hair at the central scalp, and it spreads centrifugally.

Usually, your hair at the lateral and posterior scalp is spared. 

During the study, Mariya Miteva and Antonella Tosti found that a variety of CCCA may affect the lateral and posterior scalp.

CCCA can sometimes affect the lateral and posterior scalp. Doctors can misdiagnose this variety as Traction Alopecia without proper examination.

Stages of CCCA

An image showing three stages of hair loss in CCCA.Source: jamajournal
Representation of three stages of CCCA

CCCA is a slow and progressive condition.

It involves a small area in the beginning and grows outwards, affecting most of the crown area.

Below mentioned are the three basic stages of CCCA:

Early stage

At this stage, hair may not grow at a normal pace.

Your hair may become thinner, finer, brittle, and difficult to style. Your scalp may become more noticeable.

Moderate stage

You will start to notice patchy hair loss due to increased scar tissue.

Smooth areas are visible on the scalp, and it will be difficult to camouflage the affected areas.

Severe stage

At this stage, the affected area is completely smooth. Most hair follicles are destroyed during this stage.

In most cases, the transition from mild to the severe case can take years. But in some cases, it may take only weeks or months.

You will have the best results if you start treatment in the early or moderate stages.


Hair breakage in the center of the scalp is the first sign of CCCA.

If you have CCC Alopecia, you may suffer from the following scalp discomforts:

  • Itching
  • Pain
  • Soreness
  • Tingling sensations

Additionally, you may experience Burning, Tenderness, Stinging, Pins- and-needles sensations.

Some patients may not experience any of these symptoms but only hair loss.


A person with a tight hairstyle.Source: Rushay_Booysen_@rushay_from_Rushay's_Images
A person with cornrows

The most common risk factor for CCCA is genetics. It can also be seen in people who have Keloids and Fibroids.

Several tight and heavy hairstyles, such as weaves, cornrows, locks, or tight ponytails, may cause it.

Also, hair styling tools like hair straighteners, hair dryers, and curling irons can contribute to hair loss. The use of chemical relaxers can worsen CCCA.


A person with hair loss is being diagnosed for CCCA.Source: fotojog_from_Getty_Images_Pro
A person with hair loss

You can diagnose Central Centrifugal Cicatricial Alopecia in two ways.

Clinical diagnosis

In the clinical exam, a dermatologist evaluates your scalp for a pattern of hair loss using a dermatoscope.

Your doctor will see if you still have hair follicle openings and check for any signs of inflammation.

Your and your family’s medical history is also evaluated. Including age, sex, and hair care practices.


In histopathology, a skin biopsy of the affected area of the scalp is done.

If you have CCCA, then a biopsy may show the following results.

  • Inflammatory cells around hair follicles
  • Loss of Sebaceous glands (oil glands)
  • Premature damage of the hair follicles

Your doctor may take skin scrapings and swabs if scale or crust is present. This is to exclude the fungal or bacterial infection possibility.

CCCA can sometimes affect the lateral and posterior scalp. Doctors can misdiagnose this variety as Traction Alopecia without proper examination.

Thus it is important to diagnose the condition properly before starting the treatment.


Early treatment can prevent CCCA from spreading more and causing permanent damage to hair follicles. You may have hair regrowth if you start the treatment early.

In most CCCA patients, commonly used medical treatments are:

  • Cortisone Injections
  • Corticosteroids
  • Strong steroid creams
  • Anti-inflammatory medications

Topical Minoxidil is a daily prescription that pushes hair follicles into the Anagen phase.

Products containing MinoxidilApprox. cost
Hair 4u 2%$ 6.60
Hair 4u 5%$ 21.61

It also increases the thickness of hair.

Besides these medications, Platelet Rich Plasma Therapy is also an option for hair loss treatment.

In PRP Therapy, your blood is processed to create platelet-rich plasma and injected into the affected area of the scalp. These platelets release growth factors that improve your hair’s health and regrowth.

Regular treatment of PRP is required for better results.

Before taking a PRP treatment, speak with your doctor if you have the following diseases:

  • Autoimmune disorder
  • Uncontrolled thyroid disease
  • Uncontrolled diabetes

A study suggests that another innovative treatment for CCCA is Keralase laser therapy in which microchannels are created on the scalp using a laser.

Through these microchannels, growth factors are poured. This increases the blood flow and nutrient supply surrounding the hair follicles.

If you are in the severe stage of CCCA, hair transplantation and wigs can be an option.

Natural treatment

Essential oils for natural treatment.
Essential oils

Besides the several treatments for CCCA, natural treatment is a popular option among patients.

Here are some natural treatments for CCC Alopecia:

Olive oil

Everyone knows about the Olive oil benefits for hair.

Extracted from Olives, Olive oil, when used as a supplement with Tar shampoo, shows significant improvement in controlling hair shedding.

Rosemary oil

Rosemary oil is known for enhancing microcapillary perfusion, which improves blood flow circulation.

Rosemary oil is as effective as 2% Minoxidil.

Tea tree oil

Tea tree oil is an essential oil from an Australian native plant Melaleuca Alternifolia.

Terpinen-4-ol is a major component of tea tree oil that reduces inflammation.

When using essential oils, make sure to add a few drops into a carrier oil.

Studies show that these are some clinically approved natural treatments to help with CCCA symptoms.


Managing an overall healthy diet can help support the health of the hair follicles.

Minimizing food, such as dairy, sugar, and processed products, that contribute to inflammation can also promote hair follicles’ health.

You can also take hair vitamins like Nutrafol and Viviscal Pro for your hair.


CCCA is a scarring Alopecia. Once hair follicles are destroyed, hair can not grow back.

If you observe any symptoms, speak with your dermatologist and start the treatment early.

Treatment can take a long time to show the effects; thus, stay patient and positive during the treatment.

Take good care of your health during this time and if it helps, join the support groups.

Frequently Asked Questions

Will my hair ever grow back from CCC Alopecia?

If you start the treatment in the early stages of CCCA, you may be able to reverse the effects of the condition. CCCA is a scarring hair loss. Thus, unfortunately, once hair follicles are destroyed, your hair will not grow back.

What is the best treatment for CCC Alopecia?

Topical steroids are an effective option for mild CCCA. At severe stages of CCCA, these medications are usually prescribed along with Immunosuppressants.

How do you treat Alopecia naturally?

There are several options to control hair loss due to CCCA. Essential oils are one of the popular options due to their anti-inflammatory properties.

WowRxPharmacy uses only high-quality sources while writing our articles. Please read our content information policy to know more about how we keep our content reliable and trustworthy.

More Articles Like This

Leave a Comment

Receive the latest articles in your inbox!