Central Centrifugal Cicatrical Alopecia

CCCA is a scarring alopecia that primarily affects the crown or vertex of the scalp, with progression in a symmetrical pattern, leading to permanent hair loss. It most commonly affects women of African descent. Although initially thought to be related to hair-care products (hot combs and chemical relaxers), it is now known that many patients have recognizable genetic mutations in PADI3. It is likely that both genetic and environmental factors are involved, although the exact cause remains unknown.

CCCA begins with a patch of hair thinning on the midline of the posterior portion of the crown. Over time, the area of involvement widens, and more hair is lost. Examination of the scalp will show loss of the follicular ostia corresponding with scarring alopecia. Some patients may report pain, tenderness, or itching, but many cases are asymptomatic.