What Causes CCCA? Genetics, Inflammation & Hair Care

Many women diagnosed with Central Centrifugal Cicatricial Alopecia (CCCA) feel a deep sense of guilt, wondering if they caused their hair loss by not taking good enough care of their hair. The most important thing to know is this: CCCA is a complex medical condition, not a punishment for “bad hair care.” While certain styling practices might irritate the scalp, CCCA is a multifactorial condition driven by internal biological factors—including genetics and inflammation—rather than just how you style your hair ^[1].

What We Know vs. What is Still Uncertain

• What is known: CCCA is a progressive type of scarring hair loss. It involves active inflammation that, over time, can permanently destroy the hair follicle (the tiny pocket in the skin that grows a hair) ^[2]. It is most common in women of African descent, though it can occur in others ^[3].
• What is uncertain: The exact trigger for this inflammation is still being researched. CCCA is considered a “multifactorial” disease, meaning a combination of genetics, immune system reactions, and potentially environmental factors (like physical or chemical stress) work together to cause the condition ^[1][4].

The Role of Genetics and Biology

Recent genetic studies have found that some people with CCCA carry rare variations in specific genes related to hair structure, most notably a gene called PADI3 ^[5].

PADI3 helps produce an enzyme that is essential for building a strong, healthy hair shaft ^[6]. Based on these studies, researchers have proposed a model for how the disease might develop: in a subset of patients with this genetic variation, the hair shaft forms with structural weaknesses ^[7]. This vulnerability may trigger a biological chain reaction where the protective sheath around the hair breaks down ^[8], prompting the immune system to send inflammatory cells to the area ^[2]. Eventually, chronic inflammation leads to fibrosis (scarring), meaning the follicle is permanently replaced by scar tissue and can no longer grow hair ^[2].

It is important to note that genetic susceptibility is only part of the puzzle. Not everyone with CCCA has these identified gene mutations, and having a family member with CCCA does not guarantee you will develop it ^[9]. Because of this, routine genetic testing is not currently a standard way to diagnose or predict CCCA.

The Truth About Hair Care and Styling Myths

For decades, many believed that chemical relaxers, weaves, hot combs, or high-tension styles were the primary cause of CCCA. However, research into the link between these styling practices and CCCA has produced mixed and inconsistent results ^[4][10]. While high-tension hairstyles are a known cause of a different type of hair loss called traction alopecia ^[11], they are not established as the sole cause of CCCA ^[4].

Similarly, while chemical relaxers can cause chemical burns, scalp irritation, or weaken the hair shaft ^[12], evidence does not show that they independently start the specific scarring process seen in CCCA ^[2].

However, if you have a susceptible scalp, harsh chemicals, intense heat, or heavy tension can aggravate the area or cause overlapping injuries ^[1]. This is why dermatologists strongly recommend adopting gentle styling habits to protect the hair you have ^[13]. Avoid styles that cause pain, pulling, or persistent tenderness, and protect your scalp from chemical burns. Taking these precautions is about managing a medical condition and reducing extra stress on your follicles—not an admission that your past choices caused the disease.

Recognizing Inflammation and Seeking Care

Because CCCA causes permanent scarring, early diagnosis is crucial. The goal of treatment is to calm the active inflammation and preserve the hair follicles you still have; once a follicle is fully scarred, it generally cannot regrow hair.

A clinician must evaluate your hair loss pattern, scalp history, and sometimes perform trichoscopy (a magnified look at the scalp) or a biopsy to confirm a CCCA diagnosis, as other conditions can look similar ^[13][14].

Signs of active inflammation include:

• Itching, burning, or persistent tenderness
• Redness or scaling on the scalp
• Pustules (small bumps)
• Rapidly spreading thinning at the crown

It is also important to know that CCCA can progress “silently” with mild or no symptoms, so regular monitoring by a dermatologist is important even if your scalp feels completely fine.