What Causes CCCA Hair Loss?

By the Edge Naturale Editorial Team · Medically reviewed by Shelia Davis, Edge Naturale Medical Team · Last updated June 2026

Part of our guide: What's Causing Your Edges to Thin? Hair Loss Conditions Explained

Quick answer: Central centrifugal cicatricial alopecia (CCCA) is a scarring hair loss condition that starts at the crown and spreads outward. It destroys hair follicles through chronic inflammation, leaving scar tissue behind. Genetics, certain hair care practices, and possibly underlying health conditions can all play a role.

What exactly is CCCA and why does it scar the scalp?

CCCA is a permanent scarring alopecia, meaning the follicle itself gets replaced by scar tissue over time. Once a follicle is fully scarred, hair cannot grow back from it. That is why catching it early matters so much.

The scarring happens because of ongoing inflammation deep inside the follicle, specifically around the isthmus, which is the middle segment of the hair follicle where the oil gland attaches. Researchers believe something, whether genetic, mechanical, or chemical, triggers immune cells to attack this zone. The body keeps sending inflammatory cells, and eventually the follicle collapses and fibrous tissue fills the space.

Dermatologists sometimes call this a lymphocyte-driven process. That means the immune system's lymphocytes are the main attackers, not bacteria or fungi. Antibiotics and antifungals will not stop it on their own.

Who gets CCCA most often?

CCCA disproportionately affects Black women. Research published in the Journal of the American Academy of Dermatology has consistently found this pattern, and it is one of the most common forms of scarring alopecia seen in Black women in the United States. It can also appear in Black men, usually starting at the vertex (crown) of the scalp. Other ethnic groups can develop it, but far less frequently.

It tends to show up in women in their 30s and 40s, though it has been diagnosed in women as young as their 20s and as late as their 60s. It often gets written off for years as general thinning or normal shedding, which delays real treatment.

What are the actual causes?

Honest answer: the full picture is still being studied. But here is what the evidence points to right now.

1. Genetics

A landmark 2019 study in New England Journal of Medicine identified variants in the PADI3 gene in women with CCCA. PADI3 makes an enzyme involved in forming the inner root sheath of the hair follicle. When this structural protein is faulty, the follicle wall may be more fragile and more prone to inflammatory damage. This does not mean everyone with CCCA has a PADI3 mutation, but it confirms a real genetic component exists.

If your mother, aunt, or grandmother had thinning at the crown, pay attention. Family history is one of the strongest risk signals.

2. Hair care practices that stress the follicle

Tight braids, heavy extensions, long-term weave use, relaxers, and heat applied repeatedly to the same area can all create the kind of chronic low-grade trauma that may trigger or worsen inflammation in a follicle that is already genetically vulnerable. The American Academy of Dermatology notes that traction from hairstyles is a known contributor to follicular damage in the crown area.

This does not mean protective styles cause CCCA in everyone. Most women who wear braids or weaves never develop it. But in someone whose follicles are already predisposed, sustained mechanical stress may be enough to start the inflammatory cascade.

3. Chemical damage to the inner root sheath

Relaxers work by breaking down the protein bonds in hair. Applied too frequently or left on too long, they can penetrate the scalp and damage the same inner root sheath structures implicated in the PADI3 research. Again, relaxers do not cause CCCA universally, but the overlap is real enough that many dermatologists recommend reducing or eliminating their use once CCCA is diagnosed.

4. Possible links to metabolic health

Some dermatology research suggests associations between CCCA and uterine fibroids and type 2 diabetes, conditions that are also more common in Black women. The proposed connection involves systemic inflammation and hormonal factors, though researchers have not yet established a direct causal chain. If you have CCCA and fibroids or blood sugar issues, bring up all of it with your doctor.

5. Scalp microbiome disruption

This is an emerging area. Some researchers think imbalances in the scalp's microbial environment may amplify follicular inflammation in people already genetically susceptible. The evidence is preliminary, but it is one more reason that harsh sulfate shampoos and heavy product buildup are worth addressing.

How do you tell CCCA apart from other hair loss?

A scalp biopsy is the only definitive way to confirm CCCA. If your dermatologist has not mentioned a biopsy, ask for one.

What should you do if you suspect CCCA? A numbered action plan

1. See a board-certified dermatologist, ideally one who specializes in hair disorders or sees a high volume of Black patients. Early diagnosis is the single most important step. Scar tissue cannot be reversed, but inflammation can be slowed.
2. Request a scalp biopsy. Photos and clinical exams are helpful, but a biopsy from the active edge of the patch tells your dermatologist exactly what kind of inflammatory cells are involved and how far the scarring has progressed.
3. Reduce mechanical stress on your scalp. Give your crown a break from tight styles, heavy extensions, and heat. This does not mean giving up protective styles forever, just giving inflamed follicles less to deal with while you treat.
4. Rethink your chemical services. Talk to your dermatologist about timing and frequency of relaxers or other chemical treatments. Many women with CCCA choose to transition to natural styles during treatment.
5. Support scalp circulation with a gentle daily massage. Scalp massage may help with blood flow to follicles that are not yet scarred. A clean, stimulating product like the Follicle Enhancer, made with peppermint, argan, jojoba, and coconut, can make the massage more comfortable and may support the health of follicles that are still active. It will not reverse scarring, but healthy follicles at the periphery are worth protecting.
6. Ask about medical treatments. Dermatologists commonly use topical or injected corticosteroids, hydroxychloroquine, or tetracycline-class antibiotics (for their anti-inflammatory, not antimicrobial, effects) to calm the inflammation. These are prescription treatments and need medical supervision.
7. Monitor consistently. CCCA can be slow and quiet for long stretches, then flare. Photograph your crown monthly in good lighting. Bring those photos to follow-up appointments.

Frequently asked questions

Is CCCA always permanent?

The scarring that has already happened is permanent. Hair cannot grow back from destroyed follicles. But if you catch CCCA while there is still active inflammation and not yet full scarring, treatment can slow or stop the progression and preserve the follicles that remain.

Can CCCA come back after treatment?

Yes. CCCA can be quiet for years and then become active again. This is why ongoing monitoring matters even after symptoms improve. Many dermatologists keep patients on a low-maintenance regimen to reduce flare risk.

Does wearing natural hair prevent CCCA?

Not necessarily. CCCA has a genetic component, so hair texture or styling choice alone does not determine whether you get it. That said, avoiding chronic mechanical tension on the crown may reduce one of the known contributing factors, which is worth doing regardless.

Is CCCA the same as traction alopecia?

No. Traction alopecia is caused specifically by sustained physical tension on the hair, usually at the hairline and temples. It does not typically scar unless it has been severe and untreated for a very long time. CCCA is a separate condition driven by immune-mediated inflammation, starts at the crown, and causes scarring as part of its core process. The two can coexist, but they have different causes and treatments.

Should I stop protective styles if I have CCCA?

Talk to your dermatologist. The general guidance is to reduce tension, especially at the crown, while you are in active treatment. Some protective styles with minimal tension may be fine. The goal is to remove variables that add stress to already inflamed follicles, not to punish yourself for styling choices you made before you had a diagnosis.

Can men get CCCA?

Yes. CCCA in men is less commonly discussed but well documented. It typically presents as thinning or hair loss at the crown of the scalp and follows a similar inflammatory pattern. Black men are the most affected group.

This article is for education and is not medical advice. If you are worried about hair loss, see a board-certified dermatologist. These statements have not been evaluated by the FDA. Edge Naturale products are not intended to diagnose, treat, cure, or prevent any disease.