CCCA Alopecia
Symptoms
Symptoms of Central Centrifugal Cicatricial Alopecia
CCCA is a progressive form of hair loss that develops gradually, often making it difficult to recognize in its early stages. This is why it’s commonly mistaken for normal male pattern baldness (androgenetic alopecia).
However, unlike male pattern baldness, which typically follows a predictable pattern, CCCA hair loss is also characterized by inflammation and scarring.
Below are the key symptoms associated with CCCA in men:
Gradual thinning at the crown. Hair loss typically begins at the crown of the scalp and slowly spreads outward in a circular pattern. This may initially look like male pattern baldness, but as CCCA advances, the thinning areas become more noticeable and difficult to conceal.
Scalp tenderness. Many men with CCCA experience sensations of tenderness, burning, or soreness around the affected scalp skin. This is a symptom of active inflammation, which plays a key role in follicle damage. If CCCA isn’t medically addressed, ongoing inflammation can cause permanent scarring on the scalp as well as irreversible loss of hair in these areas.
Itching and irritation. Many guys with CCCA report frequent itching or a tingling sensation on their scalp, especially where hair is starting to look sparse. This might be an early warning sign that inflammation is affecting hair follicles—and scratching may worsen irritation.
Shiny, smooth scalp. As hair follicles become scarred and damaged from CCCA, the scalp eventually starts to look smooth and shiny. This is due to scar tissue formation (called fibrosis) replacing normal follicular structures. When this occurs, it usually indicates hair loss has become permanent.
Redness or inflammation. Some men who have CCCA notice redness or mild swelling in thinning areas, which is a symptom of ongoing irritation. Sometimes this irritation is accompanied by acne-like bumps or flaking. The red areas may also feel warm or otherwise more sensitive when you touch them.
Recognizing the symptoms of CCCA early is crucial for slowing its progression and avoiding permanent hair loss. If you notice unusual hair thinning or discomfort around your crown, it’s always best to seek medical advice for a proper evaluation.
Do these symptoms sound familiar?
Risk Factors
Risk Factors for Developing Central Centrifugal Cicatricial Alopecia
Certain factors may increase the likelihood of men developing CCCA:
Family history. Genetics might have a role in the development of CCCA, and men with a family history of this or other forms of scarring alopecia could be at higher risk.
Race. CCCA appears to be most common among Black women and men.
Chronic scalp inflammation. Prolonged inflammation of the scalp can weaken hair follicles and lead to permanent scarring over time. This may be caused by autoimmune responses (though this is still uncertain), underlying scalp conditions, or environmental irritants.
Hair treatments. While not a direct cause of CCCA, regular use of hot tools or harsh treatments like chemical relaxers can damage the scalp and weaken hair follicles, which can promote inflammation and follicle scarring.
Tight hairstyles. Wearing tight braids, dreadlocks, or ponytails for long periods can put excessive stress on the hair follicles. Repeated tension on your hair might trigger inflammation and contribute to hair loss or traction alopecia, especially at the crown.
Skin conditions. Fungal infections, dandruff, or seborrheic dermatitis can encourage scalp irritation and inflammation. If left untreated, these may contribute to follicular damage and exacerbate CCCA.
Type 2 diabetes. While we still need studies in men, some research in women has linked type 2 diabetes to a higher risk for CCCA.
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Treatment
Treating CCCA
CCCA treatment options are limited. But because this is a progressive condition, it’s important to start managing it as early as possible to help slow hair loss and preserve your remaining hair.
Some of the commonly used central centrifugal cicatricial alopecia treatment options include:
Medications
Systemic or topical steroids. Corticosteroids help reduce inflammation and slow the immune response that leads to follicular scarring. Topical corticosteroid creams or ointments are often the first line of treatment, but for more advanced cases, your provider may recommend corticosteroid injections directly into the scalp. Regular use under medical supervision can help prevent further damage while preserving active hair follicles.
Oral tetracyclines. Low-dose antibiotics, such as doxycycline, may be prescribed to help reduce inflammation and slow down follicular damage. These medications do not directly promote hair regrowth but can help control the underlying inflammation that worsens CCCA. Antibiotic therapy is usually combined with other treatments, such as corticosteroids or topical medications, for better results.
Topical minoxidil. The generic name for Rogaine®, topical minoxidil is an FDA-approved hair loss medication. While research on minoxidil for CCCA is limited, it may increase blood flow to hair follicles and promote hair regrowth. Minoxidil only works for as long as you use it, and discontinuation may lead to a gradual return of hair thinning. It also can’t reverse scarring.
Platelet-rich plasma (PRP) therapy. PRP therapy for CCCA involves drawing a small amount of blood, processing it to concentrate the platelets (red blood cells involved in clotting), and injecting it into your scalp. The growth factors in PRP may help stimulate hair follicles and improve scalp health, potentially slowing CCCA progression. However, research on the use of PRP for CCCA is limited. Some research suggests it only helps mildly and temporarily, while other studies find the effectiveness has to do with the number of platelets used: More platelets seem to be associated with better results in increasing hair density.
Lifestyle Habits
Your everyday actions play an important role in your overall wellness and can help support a healthy scalp, especially when there’s something going on underneath the surface. While lifestyle tweaks can’t treat CCCA, adopting healthier habits is never a bad idea.
To prevent further irritation and follicular damage, avoid excessive heat styling, harsh chemical treatments, and tight hairstyles. Maintain a gentle scalp care routine with sulfate-free shampoos and moisturizing oils to support overall scalp health.
Finally, a nutrient-rich diet with a variety of sources of iron, vitamin D, and omega-3 fatty acids may help reduce inflammation and promote hair strength.
Hair Transplant
For men with advanced CCCA, where significant scarring has led to permanent hair loss, hair transplant surgery might be an option. However, the success of these procedures is less predictable because of the scarring and inflammation involved with CCCA.
