Is scarring alopecia the same as traction alopecia?

No, they are different conditions. Traction alopecia is caused by physical tension on the hair and is generally reversible if you catch it before the follicle scars. Scarring alopecia involves inflammation or infection that destroys the follicle from within, and the cause is not just mechanical tension. Some dermatologists believe chronic traction can eventually contribute to scarring changes, which is one more reason to address tight styles early.

Can scarring alopecia grow back?

Once a follicle has been replaced by scar tissue, it cannot produce hair again. The goal of treatment is to stop progression and preserve the follicles that are still functioning. In stable, long-term remission, hair transplants to the scarred area are sometimes possible, but that conversation belongs with a specialist.

Does CCCA only affect Black women?

CCCA is far more common in Black women than in any other group, and researchers are studying both genetic factors and styling practices as contributing elements. It does occur in other women, but the disparity is significant enough that the dermatology community has recognized it as a condition that specifically and disproportionately affects Black women.

What does scarring alopecia feel like?

Many women with CCCA or lichen planopilaris report itching, tenderness, or a burning sensation on the scalp, sometimes before visible hair loss appears. Others have no symptoms at all and only notice the hair loss later. The absence of symptoms does not mean the disease is absent, which is why regular scalp checks matter, especially if you have a family history.

Can I still wear braids or weaves if I have scarring alopecia?

Talk to your dermatologist before making that call. Some patients in stable remission wear low-tension protective styles carefully. Others find that any added tension worsens their condition. There is no single rule here because the types differ and individual scalps differ. What you should not do is wear heavy or tight styles and assume it will be fine without getting medical guidance first.

How do I find a dermatologist who knows about scarring alopecia in Black women?

Start at aad.org and filter for hair loss specialists. You can also search for dermatologists who are members of the Skin of Color Society, an organization focused on dermatology for patients with skin of color. Ask the office directly whether the doctor has experience with CCCA or cicatricial alopecia before you book. It is a fair question and a good filter.

Scarring Alopecia: What It Actually Is and What You Can Do

June 13, 2026

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

Quick answer: Scarring alopecia is a group of hair loss conditions where inflammation destroys the hair follicle and replaces it with scar tissue. Once a follicle scars over, it cannot regrow hair. That sounds terrifying, but most cases are caught early enough that you still have options.

Why Does Scarring Alopecia Feel So Different From Regular Hair Loss?

Most hair loss is reversible. Postpartum shedding, stress, even traction alopecia caught early, those follicles are still alive. Scarring alopecia is different because the follicle itself is destroyed. The American Academy of Dermatology classifies these as "cicatricial alopecias," a family of disorders where your immune system, an infection, or chronic inflammation attacks the follicle from the inside out.

The result is permanent. No oil, no biotin, no growth serum brings back a follicle that has been replaced by scar tissue. That is the hard truth. But here is what people miss: the window between early scarring and full scarring is real, and what you do in that window matters enormously.

What Are the Most Common Types?

There are several forms, and they do not all look the same.

Central Centrifugal Cicatricial Alopecia (CCCA): The most common type in Black women. It starts at the crown and spreads outward in a circular pattern. Research published in the JAMA Dermatology has found a genetic link, and it disproportionately affects Black women. Chemical relaxers and heat have been studied as possible aggravating factors, though researchers are still sorting out cause versus correlation.
Lichen Planopilaris (LPP): An autoimmune condition that attacks the follicle. You may see redness, scaling, and a burning sensation around hair follicles, especially at the hairline.
Frontal Fibrosing Alopecia (FFA): A slow recession of the entire frontal hairline, often with eyebrow loss. It is increasingly common and still being studied.
Folliculitis Decalvans: A bacterial-driven form causing pustules, crusting, and patchy loss, most often at the crown.
Discoid Lupus: Lupus affecting the skin can cause scarring hair loss. This one needs a rheumatologist involved, not just a dermatologist.

How Do You Know If It Is Scarring or Non-Scarring Alopecia?

You cannot tell for certain at home. A dermatologist uses a dermoscopy tool to look at the scalp up close, and in many cases they do a scalp biopsy, a small skin sample taken under local anesthetic, to confirm whether follicles are scarred. This is non-negotiable if you are worried. Guessing wrong and treating a scarring alopecia like traction alopecia wastes time you do not have.

That said, there are warning signs worth knowing.

Sign	More likely scarring	More likely non-scarring
Scalp texture	Smooth, shiny, no follicle openings visible	Normal texture, follicles still visible
Symptoms	Itching, burning, tenderness, scaling	Often no scalp symptoms
Pattern	Crown spreading outward, or hairline receding uniformly	Patchy, diffuse, or follows tension lines
Hair regrowth after rest	No regrowth even after removing tension	Regrowth possible once cause is removed

A Step-by-Step Plan If You Think This Might Be You

Stop adding inflammation now. Before you even get a diagnosis, pull back on anything that stresses the scalp: tight braids, glue, heavy weaves, high-heat tools, and relaxers. You are not giving up those things forever. You are buying your follicles time while you get answers.
Book a board-certified dermatologist, specifically one who specializes in hair loss. Look for the terms "hair loss specialist" or "trichology" in their profile. The AAD has a find-a-dermatologist tool at aad.org. A general practitioner is not enough for this one.
Get a scalp biopsy if recommended. It sounds scary and it is actually minor. A biopsy is the only way to confirm whether follicles are scarred and which type of scarring alopecia is present. Type matters because treatments differ significantly.
Follow the treatment plan your dermatologist prescribes. For most scarring alopecias, the goal of treatment is stopping progression, not reversal. Common approaches include topical or injected corticosteroids, hydroxychloroquine for autoimmune types, antibiotics for folliculitis decalvans, or newer biologics in research settings. Do not skip doses because you feel like it has stopped. Remission requires consistency.
Support what is still alive. In areas where follicles are not yet scarred, gentle stimulation of the scalp may support circulation and a healthy scalp environment. This is where a product like the Follicle Enhancer fits in, massaged into the edges and any areas your dermatologist confirms still have active follicles. Peppermint, jojoba, and argan oil can help with scalp health and comfort. Massage itself has been studied for its effect on dermal papilla cells. Just be clear: this is care for living follicles, not a treatment for the disease.
Talk about hair restoration options if the scarring is established. Hair transplants can work on stable scarring alopecia, meaning the disease has been in remission for at least one to two years. A hair restoration surgeon experienced with cicatricial alopecia can tell you if you are a candidate.

What Myths Do People Get Wrong About Scarring Alopecia?

Myth: "It only happens to older women." CCCA has been diagnosed in Black women as young as their twenties. Age is not the gate here.

Myth: "It is just from braiding too tight." Tight styles cause traction alopecia, which is different and generally non-scarring if caught early. CCCA and other cicatricial forms have internal, often autoimmune or genetic causes. Protective styles are not automatically the villain, but they should not be worn excessively tight regardless.

Myth: "Once I see smooth scalp, it is too late to do anything." Smooth scalp in one patch does not mean the entire area is lost. The border of a scarring alopecia patch is where the active disease lives, and slowing or stopping it there protects what is still viable.

Myth: "Natural products will reverse it." Nothing reverses established scarring alopecia. Anyone selling you a product with that promise is taking your money. Honest answer: the only thing that stops a scarring alopecia is medical treatment targeting the inflammation or infection driving it.