Hair loss types: Central centrifugal cicatricial alopecia causes
What causes central centrifugal cicatricial alopecia (CCCA)?
This type of hair loss destroys hair follicles (tiny openings from which your hair grows) on your scalp. Once a hair follicle has been destroyed, it scars. When this happens, treatment becomes more difficult and hair loss is more likely to be permanent.
What causes this scarring is complex and not yet fully understood. To gain a better understanding, dermatologists are studying CCCA.
Can a hairstyle or hair-grooming practice cause CCCA?
You may have heard that certain hairstyles or hair-grooming practices can cause CCCA. While hairstyles and hair grooming may play a role in causing CCCA, this has yet to be proven.
For example, it’s known that using chemical relaxers can weaken the hair, which can lead to hairs breaking off. However, dermatologists have found that some women who develop CCCA have never used relaxers. We also know that most women who use relaxers never develop CCCA.
Many Black women who use a relaxer never develop CCCA
Researchers have also found Black women who’ve never used a relaxer develop CCCA.
For this reason, it’s still unclear whether how you style your hair increases the risk of developing CCCA.
Dermatologists continue to look into the effects that hairstyles and hair grooming can have on this type of hair loss.
Is CCCA an autoimmune disease?
An autoimmune disease develops when the immune system mistakes a part of the body like the skin, hair follicles, or joints, as harmful and attacks that part of the body. Because CCCA develops when hair follicles are destroyed, it’s possible that CCCA is an autoimmune disease. However, more research is needed to know for sure.
CCCA may start when conditions are just right inside the body
The following explains what researchers have found that may play a role in causing CCCA.
It’s possible that this type of hair loss develops when conditions are just right inside the body.
For example, a woman who develops CCCA may have an infection, autoimmune disease, and certain genes, which triggers CCCA. More research is needed to understand which, if any, of these play a role.
Here’s what dermatologists have discovered so far.
A disease that causes inflammation inside your body may fuel CCCA: We know that many diseases like heart disease and diabetes cause inflammation inside the body. We also know that CCCA causes inflammation in the scalp.
For these reasons, dermatologists are trying to find out whether inflammation from another disease could lead to CCCA. In looking at numbers from the Black Women’s Health Study, researchers found that Black women who had CCCA were more likely to have type 2 diabetes than were Black women who did not have CCCA.
Another study found that 37% of Black women living with CCCA had type 2 diabetes compared to 12% of Black women who did not have CCCA.
More studies are needed to know whether there is a connection between CCCA and type 2 diabetes. In the meantime, many dermatologists recommend that their patients who have CCCA be tested for type 2 diabetes.
Family history may play a role: It’s likely that genes are partly responsible for causing CCCA. One gene called PADI3 may play a role. Changes, also called mutations, to this gene may lead to CCCA.
Researchers have also found that a certain type of hair loss may run in the families of Black women who have CCCA. In one study, Black women with CCCA were more likely to have a maternal (mother’s side of the family) grandfather who had a type of hair loss called male-pattern hair loss. This is the most common type of hair loss in men. It causes noticeable thinning, a receding hairline, or balding.
In this study, Black women who did not have CCCA were also not more likely to have a maternal grandfather with male-pattern baldness. More research is needed to prove this connection.
What all this research shows is that CCCA is a complex disease.
While we have much to learn about CCCA, one fact is known. If you have CCCA, treatment can stop further hair loss, helping you keep the hair you have.
To find out how dermatologists diagnose and treat CCCA, go to Central centrifugal cicatricial alopecia: Diagnosis and treatment.
Bolduc C, Sperling LC, et al. “Primary cicatricial alopecia.” J Am Acad Dermatol. 2016;75:1101-17.
Coogan PF, Bethea TN, et al. “Association of type 2 diabetes with central-scalp hair loss in a large cohort study of African American women.” Int J Womens Dermatol. 2019;5(4):261-6.
Gabros S, Masood S. “Central centrifugal cicatricial alopecia.” [Updated 2021 Jul 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.
Herskovitz I, Miteva M. “Central centrifugal cicatricial alopecia: Challenges and solutions.” Clin Cosmet Investig Dermatol. 2016 Aug 17;9:175-81.
Heymann, WR. “Striving to alleviate the physical and emotional scars of central centrifugal cicatricial alopecia.” In: Dermatology World: Insights and Inquiries. 11/4/2020. Last accessed 3/26/2021.
Kyei A, Bergfeld WF, et al. “Medical and environmental risk factors for the development of central centrifugal cicatricial alopecia: A population study. Arch Dermatol. 2011 Aug;147(8):909-14.
Malki L, Sarig O, et al. “Variant PADI3 in central centrifugal cicatricial alopecia. N Engl J Med. 2019;380(9):833-41.
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.
Okereke UR, Simmons A, et al. “Current and emerging treatment strategies for hair loss in women of color.” Int J Womens Dermatol. 2019;5(1):37-45.
Roche FC, Harris J, et al. “Association of type 2 diabetes with central centrifugal cicatricial alopecia: A follow-up study.” J Am Acad Dermatol. Article in Press. Last accessed 3/26/2021.
Paula Ludmann, MS
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
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