Dermatology

Validation & Orientation: Understanding CCCA

At a Glance

Central Centrifugal Cicatricial Alopecia (CCCA) is a form of scarring hair loss primarily affecting Black women. It is a medical condition often linked to a mutation in the PADI3 gene, not the result of bad hair care practices. Early diagnosis and medical treatment can help stop the inflammation.

You are not alone, and this is not your fault. For many years, thinning at the crown of the head in Black women was misunderstood, often dismissed as the result of “bad” hair care or excessive heat ^[1]. Today, medical science recognizes Central Centrifugal Cicatricial Alopecia (CCCA) as a complex medical condition with deep biological and genetic roots ^[2].

CCCA is the most common form of scarring alopecia (a type of hair loss that causes permanent damage to the hair follicle) in women of African descent ^[3]^[4]. It typically begins as a patch of thinning at the top or center of the scalp that gradually spreads outward in a circular (centrifugal) pattern ^[3].

It Is in Your Biology, Not Just Your Habits

For decades, a common myth suggested that CCCA was caused only by “hot combs” or tight braids. While certain styling practices can stress the hair, researchers have discovered that CCCA is frequently driven by a genetic mutation in the PADI3 gene ^[5]^[6].

The PADI3 gene provides instructions for making an enzyme that is essential for the structural integrity of the hair shaft ^[7].

Hair Strength: This enzyme helps “cross-link” proteins that give your hair its strength ^[8].
The Mutation: When this gene is mutated, the enzyme does not work correctly, leading to a structurally weakened hair shaft ^[5]^[9].
Inflammation: This internal weakness can trigger an inflammatory response, where the body’s immune system mistakenly attacks the hair follicle ^[10].
Scarring: Over time, this chronic inflammation replaces healthy hair follicles with scar tissue (fibrosis), making it impossible for new hair to grow ^[1]^[11].

Note: While understanding the PADI3 gene is crucial for explaining the biology of CCCA, a genetic test is not typically required to diagnose the condition ^[2].

Validating the Emotional Journey

The impact of CCCA goes far beyond the surface. Hair is often deeply tied to identity, culture, and self-esteem. It is completely normal to feel a range of intense emotions after a diagnosis, including:

Guilt and Self-Blame: Many women feel they “caused” their condition through past styling choices. Knowing the genetic basis of CCCA is a crucial step in releasing this burden ^[12].
Psychological Distress: The mental health impact of CCCA can be as significant as that of chronic skin conditions like psoriasis ^[13].
Social Anxiety: Concerns about how others perceive the thinning can lead to social withdrawal or significant changes in daily activities ^[14].

Moving Forward with Knowledge

Understanding that CCCA is a multifactorial disease—meaning it is caused by a combination of genetics, immune system activity, and environmental factors—is empowering ^[2].

Early diagnosis through trichoscopy (a painless exam using a specialized magnifier) or a scalp biopsy is vital ^[15]. While the scarring itself may be permanent, medical treatments aim to stop the inflammation, manage symptoms like itching or pain, and preserve the hair you have ^[12]. By focusing on medical management rather than self-blame, you can take control of your health journey. Return to the Home Page or proceed to Symptoms & Warning Signs.

Common questions in this guide

Is my hair care routine to blame for CCCA?

No, CCCA is a complex medical condition with biological and genetic roots. While certain tight styles can stress the hair, researchers have found that CCCA is frequently driven by a genetic mutation, not your personal hair care habits.

What is the PADI3 gene and how does it relate to hair loss?

The PADI3 gene helps create an enzyme that gives your hair its strength. A mutation in this gene can lead to a structurally weakened hair shaft, which triggers an inflammatory response that ultimately causes scarring hair loss.

How is CCCA diagnosed?

Dermatologists typically diagnose CCCA using trichoscopy, which is a painless scalp exam with a specialized magnifier. In some cases, a scalp biopsy may also be performed to confirm the diagnosis and check the level of inflammation.

Can the hair loss from CCCA be reversed?

Once hair follicles are replaced by scar tissue, the hair loss in that specific area is permanent. However, medical treatments can successfully stop the underlying inflammation, manage symptoms like itching, and preserve your remaining hair.

Do I need a genetic test to be diagnosed with CCCA?

No, a genetic test is not typically required. While understanding the PADI3 gene explains the biology of the condition, your doctor can usually diagnose CCCA based on a clinical examination of your scalp and a biopsy.

Curated prompts to bring to your next appointment.

1.What evidence from my scalp examination or biopsy suggests a genetic or biological cause rather than just external factors?
2.Can you explain how the PADI3 gene mutation might be playing a role in my specific case?
3.How do we distinguish between inflammation that can be treated and scarring that may be permanent?
4.Are there specific hair care modifications you recommend to support my medical treatment without causing further stress?
5.Can you refer me to a support group or a mental health professional who specializes in the psychological impact of hair loss?

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References (15)

1
Beyond the Hot Comb: Updates in Epidemiology, Pathogenesis, and Treatment of Central Centrifugal Cicatricial Alopecia from 2011 to 2021.
George EA, Matthews C, Roche FC, Taylor SC
American journal of clinical dermatology 2023; (24(1)):81-88 doi:10.1007/s40257-022-00740-w.
PMID: 36399228
2
Association of cicatricial alopecia with chemical hair straightening.
Marks DH, Hagigeorges D, Okhovat JP, et al.
The British journal of dermatology 2019; (181(6)):1317-1319 doi:10.1111/bjd.18217.
PMID: 31206604
3
PADI3, hair disorders and genomic investigation.
McGrath JA, Ohyama M, Simpson MA
The British journal of dermatology 2019; (181(6)):1115-1116 doi:10.1111/bjd.18463.
PMID: 31797372
4
Central centrifugal cicatricial alopecia in Black men: A case series highlighting key clinical features in this cohort.
Lubov JE, Okereke UR, Clapp B, et al.
JAAD case reports 2023; (38()):27-31 doi:10.1016/j.jdcr.2023.05.026.
PMID: 37600725
5
Pathogenic variants affecting peptidyl arginine deiminase 3 and its major substrates underlie central centrifugal cicatricial alopecia.
Keller-Rosenthal N, Sarig O, Giladi M, et al.
The Journal of investigative dermatology 2026; (146(6)):1596-1604.e2 doi:10.1016/j.jid.2025.10.609.
PMID: 41242654
6
Autosomal-Dominant Mutation in PADI3 Responsible for up to 25% of Central Centrifugal Cicatricial Alopecia Cases.
Hassan M, Netchiporouk E
Journal of cutaneous medicine and surgery 2019; (23(5)):553 doi:10.1177/1203475419860505.
PMID: 31478774
7
Variant PADI3 in Central Centrifugal Cicatricial Alopecia.
Malki L, Sarig O, Romano MT, et al.
The New England journal of medicine 2019; (380(9)):833-841 doi:10.1056/NEJMoa1816614.
PMID: 30763140
8
Structures of human peptidylarginine deiminase type III provide insights into substrate recognition and inhibitor design.
Funabashi K, Sawata M, Nagai A, et al.
Archives of biochemistry and biophysics 2021; (708()):108911 doi:10.1016/j.abb.2021.108911.
PMID: 33971157
9
Deimination in epidermal barrier and hair formation.
Méchin MC, Simon M
Philosophical transactions of the Royal Society of London. Series B, Biological sciences 2023; (378(1890)):20220245 doi:10.1098/rstb.2022.0245.
PMID: 37778378
10
Central Centrifugal Cicatricial Alopecia Associated With PDL1 Loss and Increased Expression of Caspase 3: A Case Series.
Smith SDB, Woddor N, Cassarino DS, et al.
The American Journal of dermatopathology 2023; (45(6)):418-422 doi:10.1097/DAD.0000000000002428.
PMID: 37074004
11
Characterization of the inflammatory features of central centrifugal cicatricial alopecia.
Flamm A, Moshiri AS, Roche F, et al.
Journal of cutaneous pathology 2020; (47(6)):530-534 doi:10.1111/cup.13666.
PMID: 32068905
12
Health-related quality of life (hrQoL) among patients with primary cicatricial alopecia (PCA): A systematic review.
Singh R, Wilborn D, Lintzeri DA, Blume-Peytavi U
Journal of the European Academy of Dermatology and Venereology : JEADV 2023; (37(12)):2462-2473 doi:10.1111/jdv.19381.
PMID: 37478298
13
Comorbid anxiety and depression among black women with central centrifugal cicatricial alopecia: A retrospective study.
McKenzie SA, Roche FC, Onyekaba G, et al.
The Journal of dermatology 2021; (48(1)):e19 doi:10.1111/1346-8138.15595.
PMID: 33180336
14
Quality of life in patients with central centrifugal cicatricial alopecia: a preliminary study.
Maranga A, Roche FC, Alausa M, et al.
The British journal of dermatology 2022; (187(5)):802-804 doi:10.1111/bjd.21710.
PMID: 35788915
15
Trichoscopy of Central Centrifugal Cicatricial Alopecia: A Retrospective Study and Literature Review.
Zogob LPR, Cortez de Almeida RF, Tortelly V
Skin appendage disorders 2024; (10(5)):415-420 doi:10.1159/000538912.
PMID: 39386312

This page provides educational information about Central Centrifugal Cicatricial Alopecia (CCCA) and its causes. It is not a substitute for professional medical advice, diagnosis, or treatment from a board-certified dermatologist.

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