Hair loss types: Central centrifugal cicatricial alopecia overview

What patients often ask their dermatologist about CCCA

Board-certified dermatologists are the medical doctors who have the most experience diagnosing and treating hair loss, including CCCA. When patients see their dermatologist about CCCA, they often ask the following questions.

Why am I going bald in the center of my head?

This type of hair loss often begins in the center of the scalp as a small, balding, and round patch that grows over time.

While more common in Black women, this type of hair loss develops in men and people of all races.

Central centrifugal cicatricial alopecia (CCCA)

The first sign of CCCA is often noticeable hair loss in the center, or crown, of your scalp.

If you have this type of hair loss, you want to treat it early. Starting treatment early can prevent CCCA from spreading outward and causing more permanent hair loss. Some people also have hair regrowth when treatment starts early.

Early treatment is important because this disease destroys hair follicles. These are tiny pores (or openings) in your scalp from which your hair grows. Once a hair follicle has been destroyed, it is replaced by scar tissue. This is why hair loss can be permanent.

You can tell when scarring develops by looking at your scalp. After many hair follicles develop scars, you’ll have a bald area that feels smooth to the touch.

Can CCCA be reversed?

You may be able to reverse (or grow some hair) if you treat CCCA early before hair follicles develop scars. Once a hair follicle scars completely, treatment to regrow hair becomes difficult and hair loss is more likely to be permanent.

While treatment for CCCA may not always be able to reverse the disease and regrow hair, treatment can prevent CCCA from destroying more hair follicles. This means that the patch of hair loss that you have can remain the same size instead of getting larger. Without treatment, CCCA often continues to destroy hair follicles, and the patch of hair loss becomes larger and may eventually involve most of the scalp.

How is CCCA treated?

You cannot effectively treat CCCA with hair loss treatments that you can buy online or in stores. A dermatologist must prescribe medication to treat this type of hair loss.

A dermatologist can also give you self-care tips that can make treatment more effective.

Even if you don’t want to treat the hair loss, it’s important to see a board-certified dermatologist if you have patchy hair loss in the center of your head. Occasionally, CCCA is a sign of a medical problem like a thyroid condition. The hair loss could also be a sign that you need more iron or certain vitamins.

If you have noticeable hair loss on the top of your head, dermatologists encourage you to make an appointment today. As tempting as it can be to hide a small area of hair loss, remember that the small area tends to get larger and larger without treatment.

Why does the baldness start from the top of the head?

Exactly why CCCA usually starts on the top of the head is not completely understood.

In studying CCCA, dermatologists have learned that it is a unique type of hair loss that usually starts on the top of the head. As CCCA progresses, the round patch grows.

Studies have also found that:

• Where this type of hair loss develops, there’s inflammation.

• CCCA is the most common type of scarring hair loss for women of African descent.

• In the United States, it’s the most frequent cause of scarring hair loss in African American women and usually begins during middle age.

• CCCA runs in families.

Noticeable hair loss is one sign of CCCA. Some people feel small, raised bumps on their scalp. Many people who have untreated CCCA say that their scalp burns, stings, or itches.

You may develop other signs or symptoms. You’ll find more information about these, along with pictures at Central centrifugal cicatricial alopecia: Symptoms.

Image
Image used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol. 2009;60:660-8.)

References
Bolduc C, Sperling LC, et al. “Primary cicatricial alopecia.” J Am Acad Dermatol. 2016;75:1101-17.

Felix KH, Portilla-Maya N, et al. “Poster 8658: Dermatoscopic evaluation of CCCA disease extent.” J Am Acad Dermatol. 2019;81(4)suppl. 1:AB44. No commercial support identified.

Filbrandt R, Rufaut N, et al. “Primary cicatricial alopecia: Diagnosis and treatment.” CMAJ. 2013 Dec 10;185(18):1579-85.

Fritzlaine C. Roche MS, et al. “Research letter: Association of type 2 diabetes with central centrifugal cicatricial alopecia: A follow-up study.” J Am Acad Dermatol. 2021;Article in press. Last accessed 3/31/2021.

Gathers RC, Lim HW. “Central centrifugal cicatricial alopecia: Past, present, and future.” J Am Acad Dermatol. 2009;60:660-8.

Herskovitz I, Miteva M. “Central centrifugal cicatricial alopecia: Challenges and solutions.” Clin Cosmet Investig Dermatol. 2016;9:175-81.

Mirmirani P, Willey A, et al. “Primary cicatricial alopecia: histopathologic findings do not distinguish clinical variants.” J Am Acad Dermatol. 2005;52(4):637-43.

Ogunleye TA, Quinn CR, et al. “Alopecia.” In: Taylor and Kelly’s Dermatology for Skin of Color. (second edition). McGraw Hill, USA, 2016:254-5.

Veerabagu SA, Lauth MJ, et al. “Hair stylists as screeners for scarring hair loss within the African American community: A cross sectional study.” Br J Dermatol. 2021 Jan 18. Epub ahead of print.

Written by:
Paula Ludmann, MS

Reviewed by:
Crystal Aguh, MD, FAAD
Erin McKinley Ducharme, MD, FAAD
Shani Francis, MD, MBA, FAAD
Carrie L. Kovarik, MD, FAAD
Shari Lipner, MD, PhD, FAAD
Benjamin Stoff, MD, FAAD

Last updated: 3/14/22