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Scarring · condition 01 of 18
CCCA: Causes, Symptoms and Treatment
Central centrifugal cicatricial alopecia. Starts at the crown and spreads outward, quietly.
Clinically reviewed by Dr. Nina Ross, NDServing all of Metro Atlanta
Quick answer
Central centrifugal cicatricial alopecia, or CCCA, is a scarring hair loss that begins at the crown and moves outward in a circular pattern.
Read the full answer
In the early stage the scalp often looks shiny or feels tender, and the hair at the center breaks or thins before any bald patch appears.
Because it is scarring, follicles that have already been replaced by scar tissue will not grow hair again. Follicles at the active border frequently can be saved when the inflammation is calmed early. At Nina Ross Atlanta in Sandy Springs, we read the crown at 200x magnification to separate scarred areas from areas that still have living follicles, then treat the active edge. Serving all of Metro Atlanta.
- It starts at the crown and spreads outward.
- Scarred follicles do not regrow.
- The active border can often be protected.
What you might be noticing
Symptoms in your words, and ours
Tap the one that sounds like you to see why it happens and how we figure it out.
01My crown feels tender or itchy
Scalp tenderness, pruritus, burning✋🏾
Why it happens
Tenderness, itch or burning at the crown is commonly linked to inflammation around the upper follicle, the process behind CCCA. It often shows up before thinning is obvious.
How we figure it out
We read the tender area at 200x for white halos and inflamed openings, so the spot you feel gets read even when it looks fine in the mirror.
02The center of my part looks shiny
Loss of follicular openings, atrophic shine✋🏾
Why it happens
Shine at the center is commonly linked to follicular openings being replaced by smoother tissue. The surface reflects light because the openings are gone.
How we figure it out
Magnification shows exactly where openings are still present. Where they are gone we tell you plainly, and we map the living follicles around them.
03My crown keeps breaking off
Hair shaft fragility over the vertex✋🏾
Why it happens
Breakage concentrated at the crown is commonly linked to early CCCA, when hairs at the center weaken before a patch appears. It can also be ordinary breakage.
How we figure it out
We read the hair shafts and the follicles underneath at 200x to tell breakage from early CCCA, because the two need different care.
04The thin spot is getting wider
Centrifugal spread from the vertex✋🏾
Why it happens
CCCA typically moves outward from the crown in a circle. A spot that keeps widening suggests the border is still active.
How we figure it out
We photograph the border at the same points every visit, so you can see whether it is still moving or has stopped.
05My hair will not hold a style there
Reduced density and caliber at the crown✋🏾
Why it happens
When a style will not hold at the crown, it is commonly because there are fewer hairs there and the ones left are finer.
How we figure it out
We compare density and hair thickness at the crown with an unaffected area, which shows how much is thinning and how much is scarring.
What causes it
What is actually driving it
- 01
Inflammation around the follicle
CCCA is driven by chronic inflammation at the upper follicle. Over time that inflammation replaces the follicular structure with fibrous tissue, which is why the surface starts to look smooth.
- 02
Genetic and familial factors
CCCA is reported to run in families, and research has looked at gene variants involved in hair shaft formation. A family history at the crown is worth telling us about.
- 03
Grooming history
Certain grooming practices have been associated with CCCA in some studies, although CCCA is multifactorial and these practices have not been established as the sole cause.
- 04
Metabolic and systemic factors
Associations have been described with conditions such as type 2 diabetes and thyroid disease. This is one reason your visit looks at more than the scalp surface.
More detail
Why CCCA disproportionately affects Black women
CCCA is reported far more often in Black women than in any other group. Research points to a mix of factors: inflammation at the upper follicle, familial patterns, gene variants involved in how the hair shaft forms, and associated metabolic conditions.1
Certain grooming practices have been associated with CCCA in some studies, although CCCA is multifactorial and these practices have not been established as the sole cause.
What that means for you in practice: styling is one part of the conversation. We look at the scalp, the pattern and the systems behind it before anyone tells you what caused this.
What we see that others miss
How we diagnose CCCA: trichoscopy and biopsy
A biopsy tells you what the tissue looks like at one small point. Trichoscopy at 200x tells you what the whole crown is doing right now, and you watch it on screen with us.
What we look for: peripilar white halos around the follicle, loss of follicular openings in the center, and a border where openings are still present but inflamed. That border is the part of your scalp still worth fighting for.
We photograph the same points every visit, so change is measured rather than guessed at.
How we treat it
What care looks like here
We start by mapping the crown at 200x so you can see the difference between scarred zones and the active border. Care focuses on calming the inflammation at that border first, then supporting the follicles that are still producing. Where the center has scarred, we are honest with you: that area will not regrow, and the work is holding the line around it. Everything is handled in-house.
- 01Map the crown at 200x
- 02Calm the active border
- 03Support what is still producing
Red Light Therapy
Low level light used to calm scalp inflammation and support the growth phase.
Restorative Therapy
A structured in-house program that treats the scalp and the systems behind it.
One visit. Real answers.
The $99 Hair & Body Discovery
No prepOne visitYour time, your pickNo judgmentServing all of Metro Atlanta
- One-on-one scalp health session with a certified trichologist
- 200x magnification read of your scalp, on screen, while you watch
- A full-body biofeedback scan
- Your Hair & Body Discovery Report, delivered the next day
Our promiseYou'll leave actually seeing what's happening, your scalp at 200x, the systems behind it, with your report the next day. If you don't, the $99 is on us.
Fully HSA/FSA eligible. 0% financing for qualified applicants.
You are welcome here
We are well-versed in us.
CCCA is diagnosed most often in Black women, and too many people are told it is just a styling problem and sent away. Your hair history, relaxers, braids, locs, weaves and heat included, is clinical information here, never a verdict on you.
Relaxers, braids, locs, weaves and heat. Share your full hair history. It is welcomed, never judged.
10 years of specialized care2,500+ clients seenNo judgment
Related conditions
Often confused with this
Lichen Planopilaris
An inflammatory scarring alopecia that often burns or stings before it shows.
Traction Alopecia
Tension-driven loss at the edges and part lines. Often reversible early.
Scalp Folliculitis
Tender, sometimes pus-filled bumps sitting right on the follicle.
Questions, answered
Honest answers before you commit
Can CCCA be reversed?
Scarred follicles do not regrow. That is the honest answer. What can change is the border, where follicles are inflamed but still alive. When we calm that inflammation early, we are protecting hair you still have and giving the compromised edge a chance to fill back in. Results not typical. Individual results will vary.
How do you know it is CCCA and not something else?
At 200x, CCCA shows white halos around the follicle and a smooth center where openings are gone, starting at the crown. Traction alopecia sits at the edges and part lines, and lichen planopilaris shows scale wrapped around individual hairs in irregular patches.
Do I need a biopsy?
A biopsy shows the tissue at one small point. Trichoscopy at 200x shows what the whole crown is doing right now, on screen while you watch. We tell you plainly what the read shows and what it means for next steps.
Will my protective styles be a problem?
Your styles are part of the conversation, never a verdict. Certain grooming practices have been associated with CCCA in some studies, although CCCA is multifactorial and these practices have not been established as the sole cause. We build around the hair you want to wear.
How soon should I come in?
As soon as you notice tenderness, shine or a spot that keeps widening at the crown. Early is when the active border is widest, and that border is the part we can still protect.
References
Results not typical. Individual results will vary.
Let's find out what your hair is trying to tell you.
You'll see it, or the $99 is on us. Serving all of Metro Atlanta.
Nina Ross Atlanta, 8735 Dunwoody Place, Suite 290, Sandy Springs, GA 30350. Monday to Saturday, 10:00 AM to 3:30 PM.