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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At AK Clinics, we’ve very experienced doctors that identify the causes of hair-loss and advice patients very carefully before undergoing Hair Transplant. We’ve operated many patients with different indication successfully

Understanding Cicatricial Alopecia

Cicatricial alopecia also known as scarring alopecia is a collection of hair loss condition leading to permanent hairloss. The criteria are:

  • Hair loss that occurs with permanent destruction of hair follicles
  • Often presents with inflammation arising from injury or disease

Scalp lesions may also be present, initially localized, it may become diffuse in chronic presentations. With gradual scarring, scalp becomes smooth without any evidence of hair follicles. Once scarring is initiated, hair loss is permanent.
In the case of cicatricial alopecia the upper part of the hair follicle gets inflamed. This is the area where stem cells and sebaceous gland (oil gland) are located and can get permanently damaged. If this oil gland & stem cells get destroyed the is only a remote possibility of hair follicle regeneration & hence permanent hair loss.


Cicatricial alopecia is a non-communicable disorder that can affect anyone from any race to any age but it is most common in African descendants. It is the cause of about 7% hair loss in worldwide.


Classification of Cicatricial Alopecia

Broadly cicatricial alopecia is classified into primary or secondary.

  • Primary cicatricial alopecia: lichen planopilaris, frontal fibrosing alopecia, central centrifugal alopecia, pseudopelade of Brocq, folliculitis decalvans, tufted folliculitis, and Dissecting cellulitis of the scalp.
  • Secondary cicatricial alopecia: Physical trauma, including burns and radio dermatitis, traction alopecia, neoplasms, trichotilomania, etc.

Diagnosis of Cicatricial Alopecia

  • Scalp biopsy is essential for the diagnosis of cicatricial alopecia.
  • Clinical evaluation of the scalp like itching, burning, pain, or tenderness usually signal ongoing activity. Signs of scalp inflammation include redness, scaling, and pustules.
  • Trichoscopy is used for non-invasive differential diagnosis of cicatricial alopecia.

Treatment of Cicatricial Alopecia

Primary cicatricialalopecias are treated by use of anti-inflammatory medications. The goal of treatment is to decrease or eliminate inflammatory cells that are attacking and destroying the hair follicle. Oral medications may include hydroxychloroquine, doxycycline, mycophenolatemofetil, cyclosporine, or corticosteroids. Topical medications may include corticosteroids, tacrolimus, pimecrolimus and other immunomodulator drugs. Triamcinolone acetonide, a corticosteroid, may be injected into inflamed, symptomatic areas of the scalp.

In certain group of cicatricialalopecias (folliculitis decalvans, tufted folliculitis) treatment is directed at eliminating the predominant pathogenic microbes that are invariably involved in the inflammatory process. Oral antibiotics are the mainstay of therapy, and topical antibiotics may be used to supplement the oral antibiotics. In dissecting cellulitis, pathogenic microbes are not usually present

Treatment of the mixed group of cicatricialalopecias (folliculitis keloidalis) may include antimicrobials, isotretinoin, and anti-inflammatory medication.

Recommendations on Hair Transplant, Hair Regrowth or Scalp Reduction in patients with CicatricialAlopecias


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