If you have been noticing thinning hair in the crown of your head, scalp itching, tenderness, burning, unexplained breakage, or a spot in the middle of your hair that just does not seem to grow like the rest of your hair, I want you to learn these four letters:

CCCA.

CCCA stands for Central Centrifugal Cicatricial Alopecia.

And girl, I know that sounds like a whole mouthful. 😭

That is exactly why I wanted to make this video and this blog post.

Once somebody finally broke down what CCCA actually meant to me, the condition started making so much more sense.

This is Video #2 in my CCCA hair loss series, and today I want to break down exactly what the words Central, Centrifugal, Cicatricial and Alopecia mean, what CCCA can look and feel like, why this type of hair loss can become permanent, and why paying attention to your crown before you see a completely bald spot is so important.

WATCH VIDEO #2: WHAT DOES CCCA MEAN?

 

WHAT DOES CCCA STAND FOR?

CCCA means:

Central = the center or crown of the scalp

Centrifugal = spreading outward from the center

Cicatricial = scarring

Alopecia = hair loss

Put all of that together and Central Centrifugal Cicatricial Alopecia describes a type of scarring hair loss that classically begins around the central or crown area of the scalp and can progressively spread outward.

That word “cicatricial” is especially important because CCCA is not just ordinary shedding or a bad hair day.

It is classified as a form of scarring alopecia.

According to the American Academy of Dermatology, CCCA can destroy hair follicles. Once a follicle has been destroyed and replaced by scar tissue, regrowing hair from that particular follicle becomes much more difficult and may no longer be possible.

And that is why I keep talking about this.

Because waiting until somebody has a big smooth bald spot in the middle of their head can mean waiting until the condition has already progressed much further than it needed to.

THE “C” IN CCCA: CENTRAL

The first C means CENTRAL.

CCCA classically begins around the vertex or crown of the scalp.

That is the area right around the top and middle portion of your head.

This is one of the reasons searches like these are so important:

“Why is my hair thinning in the crown?”

“Why am I going bald in the middle of my head?”

“Why won’t the hair in my crown grow?”

“Why does my crown keep breaking?”

“Why is the top of my scalp itchy?”

Those questions can sometimes be connected.

The American Academy of Dermatology explains that noticeable hair loss on the top or center of the scalp is a common feature of CCCA. Hair breakage in the center of the scalp may even appear before obvious hair loss.

That part is very important.

You do not necessarily have to wake up with a completely bald crown before something is going on.

Sometimes it starts with hair that suddenly seems shorter.

Sometimes the crown will not retain length.

Sometimes one section always looks thinner.

Sometimes you keep blaming your hairstyle, your relaxer, your natural hair texture, heat damage or breakage without realizing there may be something happening underneath the surface of the scalp.

THE SECOND “C”: CENTRIFUGAL

The second C stands for CENTRIFUGAL.

Think of something starting in the center and moving outward.

That is the classic pattern associated with CCCA.

You may initially notice a small area around the crown, but over time the affected area can expand toward surrounding parts of the scalp.

Research describes CCCA as progressive hair loss that commonly originates around the vertex and can spread outward over the scalp.

I want you to pay attention to the word progressive.

Progressive means something can change over time.

That is another reason I encourage women to take pictures of their hair.

Do not only look at your hair from the front.

Take pictures of the top.

Take pictures of your crown.

Part your hair in different areas.

Compare those pictures several months apart.

Sometimes gradual thinning is difficult to recognize because you see your own hair every single day.

But a photograph can show you things you may not notice in the mirror.

THE THIRD “C”: CICATRICIAL

Now this is the big one.

CICATRICIAL means SCARRING.

CCCA is a scarring alopecia.

When inflammation and damage around the follicle progress far enough, the normal follicular structure can eventually be replaced by fibrous or scar tissue.

That matters because the hair follicle is the structure that produces your hair.

If the follicle is still functioning, there may be an opportunity to preserve it and, depending on how far the disease has progressed, some people may experience regrowth.

But once a follicle has been completely destroyed and replaced by scar tissue, that follicle cannot simply operate normally again.

This is why early recognition matters so much with CCCA.

A scalp with advanced scarring may eventually begin to look smoother or shinier because some of the normal follicular openings have disappeared.

But again, please understand this:

You do NOT have to wait until your scalp becomes completely smooth and shiny before paying attention.

Earlier CCCA can look much more subtle.

THE “A”: ALOPECIA

Alopecia simply means hair loss.

Alopecia itself is not one specific disease.

There are different types of alopecia, and they do not all behave the same way.

For example, someone can have alopecia areata.

Someone can have traction alopecia.

Someone can have androgenetic or female-pattern hair loss.

Someone can experience temporary shedding.

And someone can have a scarring alopecia such as CCCA.

That is why saying “I have alopecia” does not necessarily tell you exactly what is happening.

The TYPE of alopecia matters.

CCCA belongs to the category of primary scarring alopecias, and it is particularly important in women of African descent. Reviews of the medical literature describe CCCA as one of the most common forms of scarring alopecia affecting women of African ancestry.

IS CCCA ONLY FOUND IN BLACK WOMEN?

No.

CCCA is strongly associated with women of African descent and is especially important in discussions about Black women and hair loss, but it is not biologically limited only to Black women.

Men and people from other racial backgrounds can also develop CCCA.

The American Academy of Dermatology notes that although CCCA is more commonly seen in Black women, men and people of other races can develop it as well.

There is even growing research documenting CCCA in younger people and adolescents.

That interested me personally because when I really look back over my own hair journey, I remember noticing problems with thinning when I was young.

I was eventually diagnosed with CCCA after having my first child in my early twenties, but when you look backward at your own timeline, sometimes you realize there were signs long before you had a name for what was happening.

MY EXPERIENCE WITH CCCA

I talk about CCCA differently because I have actually lived through this.

There was a point where my crown was so thin that I jokingly describe myself as being “George Jefferson bald.” 😭

If you know, you know.

But seriously, losing your hair can mess with you emotionally.

Especially when nobody can clearly explain why it is happening.

I experienced scalp discomfort, itching, thinning and hair loss, and eventually learned that what I was experiencing had a name.

CCCA.

I went through the traditional route.

I sought medical care.

I tried treatments that were recommended to me.

And over the years I also became extremely intentional about learning my own scalp, reducing unnecessary stress on my hair, creating gentler routines, paying attention to what was happening inside my body, and developing the products and techniques that eventually became part of Sydney Nicole Products.

Years later, I have hair covering areas of my crown that once looked drastically different.

That does not mean every scarred follicle magically came back to life.

What it taught me was the importance of recognizing what hair and follicles you still have, protecting them, reducing unnecessary trauma and being consistent instead of waiting until your hair loss becomes severe.

WAS CCCA ORIGINALLY CALLED “HOT COMB ALOPECIA”?

Yes.

And this history is important.

CCCA was once commonly referred to as “hot comb alopecia.”

Researchers originally suspected that heated hair-styling practices used by Black women were responsible for the condition.

The terminology later changed as researchers realized the condition was more complicated than simply using a hot comb.

Medical literature has also used terms including “follicular degeneration syndrome.”

Today, Central Centrifugal Cicatricial Alopecia is the recognized name.

And this matters to me because for years Black women were basically taught to look at our hair practices as if we were simply doing this to ourselves.

Research today supports a much more complicated picture.

Hair practices that create repeated tension or trauma may potentially aggravate scalp and hair problems, but CCCA is considered multifactorial, meaning researchers are investigating multiple interacting causes and risk factors rather than one single explanation.

IS CCCA GENETIC?

This is another area researchers are studying.

There is evidence that genetics can play a role in CCCA.

Researchers have observed CCCA occurring within families, and genetic studies have identified variants involving a gene called PADI3 in some people with CCCA.

A 2019 study found disease-associated PADI3 variants among some women with CCCA, supporting a genetic component to the condition. More recent research has continued investigating PADI3 and related genes involved in hair-shaft biology.

That does not mean everyone with CCCA has the same gene mutation.

It means we have moved far beyond the old idea that CCCA is simply somebody damaging her hair with a hot comb.

There is still a lot researchers are trying to understand.

WHAT CAUSES CCCA?

Here is the answer that may frustrate you:

There is not one proven cause of CCCA.

Current research suggests that CCCA is multifactorial.

Researchers continue to investigate:

Genetic susceptibility

Inflammation around the hair follicle

Hair-shaft and follicular biology

Family history

Hair-grooming practices

Traction or repeated tension

Chemical and mechanical hair trauma

Other biological and environmental factors

The American Academy of Dermatology specifically notes that although certain hairstyles and grooming practices may play a role, researchers have not proven that these practices alone cause CCCA. Some women diagnosed with CCCA have never used chemical relaxers at all.

That is a major distinction.

WHAT DOES EARLY CCCA LOOK LIKE?

One of the biggest misconceptions about CCCA is that the first sign has to be a bald spot.

It does not.

Possible changes associated with CCCA can include:

Hair breaking around the crown

Hair becoming noticeably shorter in one central area

Gradual crown thinning

A widening area of scalp visibility

Difficulty retaining length in the crown

Scalp itching

Burning

Tenderness

Pain or soreness

Changes in scalp sensation

Visible hair loss on the top of the head

A smoother scalp in more advanced areas

The American Academy of Dermatology specifically lists hair breakage as a possible early sign and notes that some people experience intense itching or scalp pain, while other people may experience very little discomfort.

That means there is not one universal CCCA experience.

CAN CCCA CAUSE AN ITCHY OR PAINFUL SCALP?

Yes.

This is another reason I want women to stop ignoring what their scalp is telling them.

Some people with CCCA report itching, tenderness, pain, burning or unusual sensations in the affected area. Research reviews and the American Academy of Dermatology both describe scalp symptoms such as itching and pain in people with CCCA.

Hair is cosmetic.

Your scalp is living tissue.

So if your scalp is repeatedly hurting, burning or itching in the same area while your hair is also thinning or breaking, that deserves your attention.

CAN HAIR GROW BACK WITH CCCA?

This is probably one of the most searched questions about CCCA.

And the answer depends heavily on the condition of the follicles.

If follicles are still present and have not been completely replaced by scar tissue, early treatment and management may help preserve existing follicles and some people can experience hair growth.

The American Academy of Dermatology explains that some people experience regrowth when CCCA is treated early, before complete scarring of the follicles has occurred.

Once a follicle has been completely destroyed and replaced by scar tissue, however, the goal becomes protecting and preserving the remaining follicles.

That is why I personally focus so much on maintenance.

Sometimes success is not only asking:

“How do I grow every single strand back?”

Success may also mean:

“How do I protect the hair I still have?”

“How do I reduce breakage?”

“How do I stop constantly traumatizing my crown?”

“How do I keep my scalp comfortable?”

“How do I maintain the progress I have made?”

Those questions matter too.

CCCA VS. REGULAR HAIR BREAKAGE

Not every broken hair means you have CCCA.

Natural textured hair can break for many reasons.

Dryness, manipulation, heat, chemicals, tension and styling practices can all contribute to hair breakage.

What makes crown breakage worth watching is when there is a PATTERN.

For example:

Your crown keeps breaking even when the rest of your hair grows.

The same area repeatedly remains shorter.

The scalp underneath that area also itches or hurts.

The density in that section slowly decreases.

The scalp becomes increasingly visible.

That is different from randomly finding a few broken hairs.

This is why I want women to learn their own hair instead of only focusing on length.

Pay attention to density.

Pay attention to your scalp.

Pay attention to patterns.

WHY CCCA CAN BE MISSED FOR YEARS

CCCA can develop gradually.

When something progresses slowly, people adapt to the change without realizing how much has changed.

You may say:

“My hair has always been thin right there.”

“My crown just grows slower.”

“I probably broke it off.”

“My stylist braided it too tight.”

“I need another hair growth oil.”

“I just need to stop using heat.”

And sometimes years pass.

Meanwhile, the pattern continues.

Research also recognizes that CCCA can resemble other types of hair loss, which can make diagnosis more challenging.

That is exactly why education is so important.

You cannot advocate for yourself about something you have never heard of.

WHY I CREATED THIS CCCA SERIES

This is exactly why I decided to sit down and make these videos.

Some of this information feels basic to me because I have lived with CCCA and studied hair and scalp health for years.

But then I realized:

It is not basic if nobody ever taught you.

There are women searching Google right now asking:

Why is my crown thinning?

Why does the middle of my hair keep breaking?

Can CCCA grow back?

What does CCCA stand for?

Is CCCA permanent?

Does CCCA cause itching?

Why am I losing hair in the middle of my head?

What causes CCCA in Black women?

Can you have CCCA without a bald spot?

What is scarring alopecia?

How do I know if my follicles are scarred?

Those women deserve information.

And if you are one of those women, I want you to know what these four letters mean before you ever need them.

MY PERSONAL CCCA HAIR AND SCALP APPROACH

Over the years, I have become much more intentional about my routine.

I focus on keeping my scalp clean, maintaining moisture, minimizing unnecessary tension, deep conditioning consistently, keeping manipulation low and actually listening to my scalp.

Some of the products I personally use in my routine include my Raw African Black Soap Hair Growth Shampoo, Rosemary & Peppermint Herbal Deep Conditioner, Scalp Soothing Mist, Organic Hair Growth Oil and Holistic Scalp Cream.

I also pay attention to what is happening inside my body.

That includes nutrition, hydration, stress, movement and blood work when appropriate.

Hair does not exist separately from the rest of you.

Your scalp is part of your body.

And this is something we are going to continue talking about throughout this series.

You can find the products I use in my personal hair and scalp routine at:

https://www.SydneyNicoleProducts.com/

FREQUENTLY ASKED QUESTIONS ABOUT CCCA ALOPECIA

WHAT DOES CCCA STAND FOR?

CCCA stands for Central Centrifugal Cicatricial Alopecia.

WHAT IS CENTRAL CENTRIFUGAL CICATRICIAL ALOPECIA?

CCCA is a type of scarring alopecia that classically begins around the crown or central portion of the scalp and can progressively spread outward.

IS CCCA SCARRING ALOPECIA?

Yes. CCCA is classified as a primary scarring or cicatricial alopecia.

WHY DOES CCCA START IN THE CROWN?

The classic pattern of CCCA involves the central or vertex scalp. Researchers are still studying exactly why this area is particularly affected.

CAN CCCA START WITH HAIR BREAKAGE?

Yes. Hair breakage, particularly around the center of the scalp, has been recognized as a possible early sign of CCCA.

DOES CCCA ALWAYS START WITH A BALD SPOT?

No. Breakage, thinning and scalp symptoms may occur before someone develops an obvious bald area.

DOES CCCA ITCH?

It can. Some people report itching, burning, pain or tenderness. Other people may have little or no scalp discomfort.

CAN CCCA HAIR LOSS BE PERMANENT?

Yes. Because CCCA can destroy follicles and replace them with scar tissue, advanced hair loss can become permanent.

CAN CCCA HAIR GROW BACK?

Hair may grow in areas where follicles have not been completely destroyed. Once a follicle has been fully replaced by scar tissue, regrowth from that follicle becomes unlikely.

IS CCCA CAUSED BY RELAXERS?

There is no evidence showing that chemical relaxers alone explain CCCA. Researchers consider the condition multifactorial, and some women with CCCA have never used relaxers.

IS CCCA CAUSED BY HOT COMBS?

CCCA was historically called “hot comb alopecia,” but research has moved away from the theory that hot-comb use alone causes the disease.

IS CCCA HEREDITARY?

There is evidence of genetic susceptibility in at least some people with CCCA, including research involving the PADI3 gene and studies documenting familial patterns.

CAN MEN HAVE CCCA?

Yes. CCCA is much more commonly discussed in women of African descent, but men can develop it.

CAN YOUNGER PEOPLE GET CCCA?

Yes. CCCA has been documented in adolescents and younger patients as well as adults.

THE BIGGEST THING I WANT YOU TO REMEMBER

Do not wait until your crown is completely bald before you start paying attention to it.

Learn your scalp.

Look at your crown.

Take pictures.

Watch your density.

Pay attention to repeated breakage.

Notice itching, tenderness or burning.

And if something keeps happening in the SAME place over and over again, stop brushing it off as “just breakage.”

The earlier you understand what is happening with your hair, the more informed your decisions can be.

That is really the purpose of this entire series.

I want more women—especially Black women—to know what CCCA is before years go by wondering why the hair in the middle of their head keeps disappearing.

And if you know somebody who has been complaining about crown thinning, scalp pain, unexplained breakage or hair loss in the center of her head, SHARE THIS WITH HER.

Sometimes the first step is simply giving somebody the name of the thing she has been trying to describe for years.

It’s time to take your crown back®. 💜👑

SCIENTIFIC REFERENCES AND ADDITIONAL READING

American Academy of Dermatology
Central Centrifugal Cicatricial Alopecia Overview
https://www.aad.org/public/diseases/hair-loss/types/ccca

American Academy of Dermatology
CCCA Signs and Symptoms
https://www.aad.org/public/diseases/hair-loss/types/ccca/symptoms

American Academy of Dermatology
What Causes Central Centrifugal Cicatricial Alopecia?
https://www.aad.org/public/diseases/hair-loss/types/ccca/causes

American Academy of Dermatology
CCCA Diagnosis and Treatment
https://www.aad.org/public/diseases/hair-loss/types/ccca/treatment

Herskovitz I, Miteva M.
Central Centrifugal Cicatricial Alopecia: Challenges and Solutions.
Clinical, Cosmetic and Investigational Dermatology. 2016.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4993262/

Blattner C, Polley DC, Ferritto F, Elston DM.
Central Centrifugal Cicatricial Alopecia.
Indian Dermatology Online Journal. 2013.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3573455/

Summers P, Kyei A, Bergfeld W.
Central Centrifugal Cicatricial Alopecia: An Approach to Diagnosis and Management.
International Journal of Dermatology. 2011.
https://pubmed.ncbi.nlm.nih.gov/22097988/

Ogunleye TA, McMichael A, Olsen EA.
Central Centrifugal Cicatricial Alopecia: What Has Been Achieved, Current Clues for Future Research.
Dermatologic Clinics. 2014.
https://pubmed.ncbi.nlm.nih.gov/24680004/

Malki L, Sarig O, Romano MT, et al.
Variant PADI3 in Central Centrifugal Cicatricial Alopecia.
New England Journal of Medicine. 2019.
https://pubmed.ncbi.nlm.nih.gov/30763140/

Keller-Rosenthal N, Sarig O, Giladi M, et al.
Pathogenic Variants Affecting Peptidyl Arginine Deiminase 3 and Its Major Substrates Underlie Central Centrifugal Cicatricial Alopecia.
Journal of Investigative Dermatology. 2026.
https://pubmed.ncbi.nlm.nih.gov/41242654/

Fatima SZ.
Central Centrifugal Cicatricial Alopecia: A Deeper Insight Into the Disease.
Wiener Medizinische Wochenschrift. 2024.
https://pubmed.ncbi.nlm.nih.gov/38383911/

Dlova NC, et al.
Autosomal Dominant Inheritance of Central Centrifugal Cicatricial Alopecia in Black South Africans.
Journal of the American Academy of Dermatology.
https://pubmed.ncbi.nlm.nih.gov/24480456/

ABOUT SYDNEY NICOLE PRODUCTS

Sydney Nicole Products creates hair and scalp care products with textured hair in mind, while continuing the education and community that began through Black Hair and Skin Care.

For hair care, scalp care and my personal product routine, visit:

https://www.SydneyNicoleProducts.com/

YouTube:
@BlackHairAndSkinCare

It’s time to take your crown back®. 💜👑