There are certain conditions that are known to most people, however, there are certain hair related problems, which are not recognised as easily. One such condition, which affects a large population, but is still relatively unknown to numerous is central centrifugal cicatricial alopecia. In this article, we aim to dissect this condition and understand every facet of this condition.

What is central centrifugal cicatricial alopecia (CCCA)?

  • Central – beginning in the centre of the scalp
  • Centrifugal – the hair loss is such that it radiates outwards
  • Cicatricial – the hair follicles are scarred
  • Alopecia – loss of hair

Central Centrifugal Cicatricial Alopecia or CCCA is actually a sub category of scarring alopecia, which is concentrated mainly on the scalp. Being a scarring alopecia, the involved hairs are lost permanently.The hair loss is gradual and there are almost no symptoms as such. But certain people have been known to feel itching, burning or even tingling on their scalp. This condition is most often observed in women of African American descent; although there have been cases of people from other races suffering from the same too. Women in their middle ages are most susceptible to this condition. This condition is not contagious.

What causes Central Centrifugal Cicatricial Alopecia?

While the exact causes of CCCA are still unknown, there are a few factors that are considered to be responsible:

  • There is thought to be a hereditary disposition
  • Improper hair care practices are perhaps the most common cause – chemical treatments such as straightening and perming that are not done properly, using excessive heat, pulling hair too much for braids or weaves.
  • There is premature degeneration of the internal root sheath and later destruction of the hair follicles.

CCCA is not a condition that presents itself immediately – it is a condition that develops over years.

What are the features of Central Centrifugal Cicatricial Alopecia?

Here are some of the most common features of CCCA:

  • There might be itching, tenderness or even a tingling sensation on the scalp
  • The condition most often starts near the top of the scalp (vertex) and spreads outwards. In many people, the scalp area that has been affected starts to become shiny. Whatever hair that does remain becomes extremely fragile and dry.
  • The hair loss will be gradual and progressive, which means that people suffering from the condition can expect massive hair loss, spread over an extended period of time.

How is Central Centrifugal Cicatricial Alopecia diagnosed?

The method of diagnosing CCCA is actually quite simple – a doctor will look at the scalp to gauge the hair loss, he or she might pull out a few hair to take a closer look at the hair follicles. A scalp biopsy is done in suspected cases to confirm the condition. The biopsy is also important to determine the presence of associated inflammation and the severity of follicular damage.Premature degeneration of the inner root sheath if present further substantiates the condition.

How can Central Centrifugal Cicatricial Alopecia be treated?

While there is no established treatment that has proven completely effective, there are few treatments that have shown certain positive effects. The aim of these treatment procedures is to ensure that the condition does not progress any further and if possible, the effects of the condition are reduced to a great extent.

  • Perhaps the most common course of treatment is the prescription of medications such as topical steroids, topical anti-inflammatory lotions or calcineurin inhibitors.
  • Doctors might also prescribe doses of oral medications such as Tetracyclines, Hydroxychloroquine.
  • Medications such as Minoxidil might also be prescribed.
  • In cases, where the hair loss is truly severe, there is also the option of a hair transplant procedure, provided the disease has been stable for a year.

What are the precautions that need to be taken by people suffering from Central Centrifugal Cicatricial Alopecia?

In most cases, it has been proven that incorrect hair practices are the leading cause for this condition, which is why ensuring that you rectify the same becomes crucial.

  • If you are someone who wears their hair in tight braids or has their hair woven regularly, you might want to discontinue the practice.
  • Avoid having any extensions put into your hair, because these too strain the hair.
  • If you are getting any hair relaxation methods done, make sure that you get the same done from a professional. There should also be a gap of a few weeks, in between each such procedure.
  • It is important that you reduce the usage of heat on your hair, which means that you will have to limit the usage of blow dryers, curling and straightening irons.

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Alopecia Awareness, Diagnosis, Treatment and Everything In Between

A lot of people might have heard of alopecia, but not everyone would know what it actually is and how it is diagnosed and treated. As a matter of fact, there would be a lot of people who would not even know that there are various types of alopecia. This article attempts to look at alopecia and all the aspects associated with it. With a series of basic questions, we will attempt to answer some of the most important queries related to this hair condition.

    The very first and most obvious question would be what exactly is Alopecia?

In the simplest of terms, alopecia is hair loss or baldness, wherein there is hair loss from the head or even other parts of the body. It is important to note that alopecia is not just about hair loss, but also the lack of hair growth. The degree of hair loss or the lack of hair growth will help decide which type of alopecia it is.

    The next question would be what are the types of alopecia?

There are several other types, most of which are described below:

  • Androgenetic alopecia: This is the most common type of hair loss and is often referred to as male or female pattern hair loss. The condition is also referred to as AGA. The condition is often caused due to genes or hormones, which means that both men and women can be affected by the same. Studies have shown that 95% men who have hair loss related issues have this condition. What is even more interesting is that even women suffer from this condition, however, their condition can be brought upon due to factors such as birth control pills, pregnancy, ovarian cysts and menopause.
  • Alopecia totalis: Considered to be an autoimmune condition, alopecia totalis can lead to the complete loss of hair on the head. As is the case with androgenetic alopecia, there are no patches of hair remaining in this condition. The reasons for this condition are still slightly unclear.
  • Alopecia universalis: In this condition, there is complete loss of hair, but this condition affects every part of the body. This means that someone who suffers from this condition, will not have hair on any part of the body. This again is thought to be an autoimmune condition.
  • Alopecia areata: This autoimmune condition leads to hair loss from various parts of the body, including the head. People suffering from this condition will notice the appearance of small patches, which seem smooth and without any scars. These patches can be multiple and appear one by one, over a period of time.
  • Scarring alopecia: This condition is caused by inflammation, which could range from burns or injury to bacterial infection or ringworms. These can cause permanent damage to the follicles and leads to loss of hair and a permanent scar.
  • effluvium:The medications used to treat cancer are really strong and they can cause hair loss. In the beginning, there are bald patches that start to appear, and then it moves onto complete hair loss. However, this type of hair loss is not permanent, and when the medications are stopped, the hair does grow back. There are certain other medications too which can cause this condition.
  • Telogen effluvium: This is another type of hair loss, in which the hair loss is more than that which would be considered normal. This condition is more like a thinning of hair, and like anagen effluvium, the hair loss is only temporary and the hair will eventually grow back.
  • Diffuse Patterned Alopecia (DPA) & Diffuse Unpatterned Alopecia (DUPA): Both these conditions are similar in nature, but have different manners of infestation. For instance, in diffuse patterned alopecia, which is an androgenetic type of alopecia, there is diffused thinning in conjunction to the stable permanent zone of hair loss. This includes the frontal part, the top as well as the vertex of the scalp. However, in diffuse unpatterned alopecia, there is no stable permanent zone, even though this too is androgenic in nature.
  • Traction alopecia: When you tie your hair too tightly or braid it by pulling the hair too much, you are inviting trouble and hair loss.
    Such hair styles tend to tug on the roots of the hair and when the roots become loose, there is bound to be breakage. When this condition is stretched over a period of time, it can even hinder the development of new hair follicles and eventually cause permanent loss of hair.
  • Alopecia barbae: This is one condition that is restricted to men, because the loss of hair is mainly on the face, more specifically in the beard area.
  • Alopecia mucinosa: In this condition, the alopecia leads to patches that are almost scaly in appearance.
  • How is the condition diagnosed?

The conditions are normally diagnosed by means of a proper physical examination, in addition to looking through the medical history. The doctor might ask several questions, including family history of hair loss, lifestyle and factors causing stress. The doctor might even pull at a few strands of hair and take them out to look at the follicles. There is the chance that the doctor might do a few tests, including blood tests to check the thyroid levels and hair analysis. In severe cases, the doctor might take a small portion of your scalp to test the same minutely.

    Can the condition be treated and if yes, then how?

While the treatment for each type of alopecia might vary and some of them are untreatable, the general course of treatment will be pretty much the same. For instance, the doctor will prescribe corticosteroids, which will be given in the form of injections, which are meant to supress the immune system.

There are several other medications such as Minoxidil and anthralin, which are also used to help with alopecia. While Minoxidil can assist with hair regrowth, anthralin alters the immune function of the skin.

In the more severe cases, doctors might ask you to wear a hair piece of go in for a restoration process. There are also hair care products which can help with the appearance of hair, allowing the same to look thicker. You could also consider products which will colour the scalp. In certain cases, psoralen with ultraviolet a light or PUVA therapy can be used. In this type of treatment, a medication called psoralen is applied on the skin, and then with the help of UV light, the skin is treated.

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“Hi, I am Mr. Goel, 32 year old male, I am Suffering from alopecia. Can you please tell me what and why I am suffering from this condition”.

Hi, Mr. Goel First of all, I would like to thank you for mailing us to know more about alopecia. The hair loss or Alopecia has got many causes and the most common cause is Androgenic alopecia.

It is a type of hair loss which is carried through the genes and is known to affect both men and women. In non-medical terms, this condition is known as male pattern baldness and female pattern baldness respectively. In such a scenario, the hair loss can start at a very early age, and there is minimal chance for regrowth. We are able to diagnose the same by observing the receding hairline and the loss of hair from the front part of the scalp. In women, this condition occurs post their 40s and for them, we have observed that there is general thinning, as opposed to men, in whom there is localised balding.

Apart from this, there are numerous other types and categories of the same. For instance, involutional alopecia is a naturally occurring condition, in which the hair starts to thin with age. This happens most often, because of more hair going into the resting phase, which leads to reduced numbers and length.

On the other hand, there is alopecia areata, which attacks the hair of young people, mostly children. In rare cases, there is something called alopecia totalis, wherein there is complete baldness with loss of entire scalp hair. However, in most cases, the hair regrows in some time. There is also a more severe version of alopecia known as alopecia universalis, wherein the hair from all parts of the body are also lost, including the eyebrows and lashes.

Then there is the condition that in medical terms is known as  telogen effluvium and is a thinning of hair, that is short lived. This happens during the transition periods between the anagen-catagen or catagen-telogen phases. Since hair is in a rest period, there is thinning and shedding, but this is generally not an elongated phase.

It will be better if you can send your pictures to us from the front top, Sides and back to give us a better picture and then we can suggest to you the treatment for the same.

Line diagram with age on X axis, percentage of baldness Y axis…

20 years 20%
30 yrs 30%
40yrs 40%
50 yrs 50%
60 yrs 60%
70 yrs 70%

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Question : Doc, I am having hair loss. Does smoking have any correlation with this? How can I stop my hair fall?

Hi Sumit, We come across such statements every day and while there is no magical solution for this, we can certainly recommend a few alterations in your lifestyle and daily habits that could bring about a visible change.

Common Causes of Hair Loss in men:

Hormonal: First and foremost, you have to understand that hair loss happens due to certain reasons or factors, which could be internal or external. For instance, almost 95% hair loss in men, is due to genetics, also known as male pattern baldness.

Dietary: In certain cases, an overdose of vitamin A is known to cause severe hair loss, while in others, there could be a deficiency of protein that leads to the same.

Diet: A healthy diet is certainly important for good hair, but we often tell our patients that alopecia, or hair loss, is not necessarily caused due to medical problems. However, if there are no enough proteins, vitamins and minerals in your diet, you are bound to have hair that is weak and such hair will eventually break.  Thus a balanced diet can help you get back your lost hair.

Smoking: Smoking, however, can lead to hair fall and studies have proven the same – smoking has shown an increase in the rate at which male pattern baldness sets in. While you might not have a lot of choice when it comes to regaining the hair you have already lost, you certainly can try to maintain the hair that you still have left  

Avoiding Chemical treatments of hair: Rebonding or straightening can damage upto 30% hair. So, you should careful and prepared before undergoing any procedure.

If you keep on losing hair, you should be want to make some lifestyle changes, because if things go truly out of hand, then follicular unit extraction or transplant might be the only options left with you!

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The term alopecia might be known to a lot of people, but not all of them would know what exactly it refers to and how it can affect a person’s life. Alopecia is the loss of hair and there are various categories, which could range from temporary loss to complete loss of hair, from all over the body. While alopecia areata and alopecia universalis are the more heard versions, there is also an entity calledcicatricial or scarring alopecia.

What is cicatricial alopecia?

Also known as scarring alopecia, cicatricial alopecia is a rare condition that destroys the follicles of the hair and all the associated oil glands, or sebaceous glands, and this leads to permanent loss of hair. This condition is seen more often in women, but cases have been reported in both sexes. Thehair loss is said to be instigated due to the inflammation caused in the upper part of the hair follicles. This is where the stem cells as well as the oil glands are, and when these are destroyed, there is next to no chance of the hair re-growing. While the condition is not contagious, it can affect anyone, man, woman and child.

Symptoms of Scarring alopecia

Hair loss can occur in a gradual completely asymptomatic manner or might be immediate and accompanied by burning sensation and pain. People may also complain of itching and scaling in some cases with presence of certain raised lesions.
There are several other factors that a doctor will enquire to make the correct diagnosis and these include:
• Onset and rate of progression
• Symptoms such as pain, burning sensation and itching
• Previous treatments, medical history and medications
• Family history of similar condition


Doctors examine such cases with a special instrument called dermatoscope to visualise the hair follicle openings and skin texture. Also a scalp biopsy is recommended to identify the exact cause of such alopecia. The biopsy has to be conducted on an area where the inflammation is still present. Even a hair pull test would be helpful in such a situation, especially to decipher where to biopsy.
A doctor might also look at pustules that might be present and use those to locate as well as identify the microbes that might prove to be contributing factors for the condition. It is important that each stage is photographed, as this assists in comparison, post treatment.


Once the cause is identified they are treated with medicines accordingly. This prevents further progression of the condition and associated hair loss. In the areas where hair follicles are already destroyed, the best option is to opt for a trial hair transplant. It is important to visit a doctor and discuss about the management options best suited to your condition.

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Question:I am 45 years old and have found more hair in my comb than would be considered normal. I have also been noticing that I can see my scalp. Should I consider a transplant and would I be an ideal candidate for it?

Hello Mrs. Sharma,
Losing close to 100 hair a day is considered normal and this is hair that will get replaced naturally. However, if you are losing more than that, there could be cause for worry.
There are different reasons for hair fall in women

  • Telogen effluvium : this is the most common type where there is a diffuse loss of hair with thinning. It can be due to a variety of causes.
  • Female pattern baldness : similar to male baldness, there is more loss of hair at the top of scalp
  • Alopecia areata : there are localised patches of hair loss
  • Cicatricial alopecia : hair loss occurring after any injury, include burns, cuts and bruises or scars from physical or chemical traumas, any scar or incision site after a cosmetic or corrective surgery
  • Use of certain medicines like anticancer drugs

Hair transplantation is an ideal option for cases of female pattern baldness and cicatricial alopecia
While men suffering from hair loss are generally good candidates, the same is not often the case with women. This is so because, men tend to have properly defined bald patches, while in women, the hair loss is more diffuse. With no clear area to work on, it becomes difficult for doctors to conduct a proper transplant process.
In men, the donor areas are generally on the sides of the head and the back part; and unfortunately in women, this is where the hair loss is most profuse. This means, that in women, there is not a proper or ‘safe’ donor area, which can provide sufficient grafts for a transplant. However, if there is a sufficiently large donor area, a transplant can be done – hair will be implanted along the hairline and this will provide an illusion of the person having dense hair.
We would request you to send us some pictures of your head (taken from different angles) or visit one of our clinics, which will allow us to provide you with a better diagnosis and management accordingly.

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What is it about hair transplants that make people feel they should go for it, as though the ads that promote ‘cures to baldness’  weave a mesmeric spell?  Many surgeons state there is a certain risk. It gives the entire medical fraternity a bad name when fly-by-night operators make tall claims and then fail to deliver. A patient who had undergone 2000 hair grafts was depressed because of his surgeon’s attitude post-surgery. Before selling him the idea of a transplant, the patient was welcomed, convinced but the situation turned sour when the grafts did not grow. To make matters worse, the patient could not even have a short hair cut due to the terrible scar he was saddled with. The recipient area had healed but the surgeon was wrong in making the patient feel as though it were his fault. A surgeon first and foremost needs to be compassionate enough to treat every patient with not just medicines and operations but also proper counseling and adequate or qualitative feedback.  As for patients, they need to do thorough research before signing up for hair transplant or any such procedure and must not consider this to be some mysterious process where the outcome hinges on chance or luck. Most factors are within the control of the surgeon and his team.

However, many times women with undiagnosed conditions like alopecia may face some problems with hair grafts.

People should be aware that as they age they will face thinning hair and not fall prey to miracle peddlers and their false promises. A transplant done at thirty years of age will have different result than one which is done later. New procedures like FUE have made inroads into hair restoration, but before opting for it, a consultation with experts is vital to avoid disappointment later. Any person going in for any kind of treatment should feel free to ask questions such as density coverage, downtime, side-effects or any other concerns like a scar. The best bet would be to seek testimonials of those who have already been through the procedure. At A K Clinics we have a dedicated team of qualified professionals who educate the patient about the procedure and dispel doubts. Our centres in Ludhiana, Delhi, Mumbai are open to people from all walks of life, who want to change their tomorrow and face it with confidence.

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