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Hair loss types: Central centrifugal cicatricial alopecia signs and symptoms

Where does central centrifugal cicatricial alopecia (CCCA) develop on the body?

This type of hair loss often affects middle-aged Black women and usually begins in the center (or crown) of the scalp. The first sign that most people see is noticeable hair loss on the top of the head.

What are the signs and symptoms of CCCA?

One sign that everyone with CCCA eventually develops is noticeable hair loss on the top of the head. Some people also develop symptoms like intense itch or pain on their scalp. Others say they never feel any discomfort. The following explains what may happen before — and after — you see noticeable hair loss.

Hair breakage

When you have hair breakage, part of the hair breaks off. This makes some hairs shorter than others, and you may see a lot more hairs on your brush. Hair breakage, especially in the center of the scalp, may be the first sign of CCCA.

Woman experiencing hair breakage while brushing her hair

Scalp feels scaly, bumpy, or crusty

Before you see noticeable hair loss, CCCA may cause some changes to your scalp. You may feel tiny bumps. Some women say their scalp feels scaly or crusty. Dermatologists think that inflammation in your scalp causes these signs.

Woman with CCCA feeling her scalp

Noticeable hair loss: Center of the scalp

CCCA gets its name from the way it causes hair loss. The first sign is usually noticeable hair loss in the center of the scalp. This is why you see the word “central” in the name. Instead of developing one patch in the center of the scalp, a few people with CCCA develop scattered patches of hair loss on their scalp. This is rare.

Black hair thinning at the crown

Scalp itches, burns, or feels painful

You may not develop these symptoms. However, some people who have CCCA develop one or more of the following symptoms on their scalp:

  • Itching
  • Pain
  • Tenderness
  • Burning
  • Stinging
  • Pins-and-needles sensation

The intensity of these symptoms varies from person to person. For some people, symptoms can become so intense that they interfere with everyday life. Treatment for CCCA can ease the pain and other symptoms.

Woman touching her temples to soothe pain caused by CCCA

Hair loss spreads outward

The hair loss tends to spread outward in a circular pattern, as shown here. This is why it’s so important to see a dermatologist at the first sign of hair loss. If you have CCCA, treatment can prevent further hair loss.

Large area of hair loss due to CCCA

Scalp appears shiny and smooth

CCCA is a disease that destroys hair follicles (the openings from which hair grows). Scar tissue then grows over the destroyed hair follicles. The scarring often gives the scalp a shiny and smooth appearance.

Scarring due to CCCA on woman’s scalp

The emotional effects of CCCA

The hair loss and symptoms like pain and intense itch can take a toll on your emotions. Women have confided in their dermatologists that CCCA makes them feel embarrassed, depressed, frustrated, or discouraged.

Research supports the claim that CCCA can affect your outlook on life. When researchers at Northwestern University surveyed Black women living with CCCA, the researchers found that 82% of women said their hair loss made them feel embarrassed, frustrated, or self-conscious.

In other studies, women said that having CCCA lowers their self-esteem. Some women said that they start to feel anxious around people.

Many women blame themselves for developing CCCA, as it was previously thought that various hairstyling practices cause CCCA. However, research suggests that how you style your hair may not play a role.

To find out what may play a role in causing CCCA, go to Central centrifugal cicatricial alopecia: Causes.

Images 1,2,3,5: Getty Images
Images 4,6,7: Journal of the American Academy of Dermatology

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  • 2005; 52:637-43

  • 2009;60:574-8

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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.

Gathers RC, Jankowski M, et al. “Hair grooming practices and central centrifugal cicatricial alopecia.” J Am Acad Dermatol. 2009;60(4):574-8.

Herskovitz I, Miteva M. “Central centrifugal cicatricial alopecia: Challenges and solutions.” Clin Cosmet Investig Dermatol. 2016;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;147(8):909-14.

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.

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.

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

All content solely developed by the American Academy of Dermatology

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