Central centrifugal cicatricial alopecia (CCCA)

What it is

CCCA is a type of scarring hair loss that starts at the crown or top of the scalp and spreads outward. Hair follicles are gradually replaced by scar tissue, so hair cannot regrow in affected areas.

How it works

CCCA is a scarring hair loss that starts at the crown and spreads outwards. Inflammation around the follicle destroys the stem cells that regrow hair, replacing them with scar tissue. It is commonest in women of African descent.

Why it matters on darker skin

CCCA mainly affects women of African descent. Genetics play a role, and heat styling, relaxers and tension may contribute. Early symptoms such as tingling, itch or tenderness at the crown are often dismissed.

Causes and triggers

Genetic tendency (variants in the PADI3 gene have been linked), and possibly heat, chemical relaxing and traction, although these are not proven causes.

What helps — and why it works

Early diagnosis is essential. A dermatologist can confirm it, sometimes with a small scalp biopsy, and start anti-inflammatory treatment to stop progression. Gentle hair practices, fewer chemicals and less heat support treatment. See a doctor or dermatologist quickly: early anti-inflammatory treatment can stop progression. Expected timeline: stabilisation over 6–12 months. Gentle hair care: reduces additional damage. Expected timeline: ongoing.

What to avoid and why

Avoid waiting and hoping it resolves, hiding thinning under tight weaves, and repeated relaxers or hot combs on the crown.

Common mistakes

• Assuming crown thinning is just breakage.
• Waiting years before getting checked.
• Hiding it with tight weaves that add traction.

Handling textured hair gently

Coily and curly hair is naturally the most fragile hair type because each bend in the strand is a weak point and natural oils travel down it slowly. That makes handling — how often and how firmly hair is combed, styled and pulled — as important as which products you buy. Detangle only when hair is wet and coated in conditioner, working in sections from the ends towards the roots with fingers or a wide-tooth comb. Keep heat to the lowest effective setting and always use a heat protectant. Sleep on satin or silk, or wear a satin bonnet, to reduce friction. Between wash days, a water-based leave-in followed by a light oil or cream helps hold moisture. Give the scalp attention too: it is skin, and needs regular cleansing, especially under wigs, weaves and braids, to prevent build-up, itch and infection. Any style that hurts, causes bumps or leaves the scalp tender is too tight and should be loosened. Hair grows about one centimetre a month, so changes in care take two to three months to show in length and thickness.

Scalp health and product choice

Choose a shampoo that suits the scalp and a conditioner that suits the lengths: the scalp may need cleansing or a medicated shampoo while the ends need moisture. Fragrance, essential oils and heavy waxes can irritate a sensitive scalp or cause build-up, and heavy oils on the scalp may worsen dandruff. Look for a clear ingredient list and a NAFDAC number, and patch-test new dyes and relaxers 48 hours before every use. Products that promise dramatic growth are usually untested; the treatments with the best evidence for pattern hair loss are medicines such as minoxidil, which should be started only after speaking to a pharmacist or doctor. Signs that you need medical advice rather than a new product include patches of hair loss, scarring or shiny skin, pain, pus, or shedding that continues for more than six months.

Questions to ask your doctor or pharmacist

Useful questions include: What do you think is causing this? Is it likely to come back, and how can I prevent it? Which products should I stop? How long before I should expect improvement, and when should I come back if it isn't better? Are there side effects to watch for? Is this treatment safe if I am pregnant, breastfeeding or for my child? Writing your questions down, bringing your products (or photos of their labels) and taking dated photos of the problem make an appointment much more useful.