Central centrifugal cicatricial alopecia (CCCA) is a type of cicatricial (scarring) alopecia that presents as an area of permanent hair loss on the crown or vertex of the scalp that expands centrifugally (picture 1A-D). Clinical signs of inflammation (eg, inflamed papules, pustules, erythema, or scale) or symptoms (eg, scalp pain, tenderness, or itching) may accompany the hair loss. Women of African descent represent the most common population affected.
Data on the treatments for CCCA are limited, and treatment of the condition is largely guided by expert opinion. Local corticosteroid therapy and oral tetracyclines are well-accepted pharmacologic interventions for CCCA. Although uncertainty remains about the role of hair care practices in the development of CCCA, minimization of practices that can be damaging to the hair and scalp often is recommended.
The clinical manifestations and diagnosis of CCCA will be reviewed here. Other forms of cicatricial and noncicatricial alopecia are reviewed separately. (See "Evaluation and diagnosis of hair loss", section on 'Classification'.)
The terminology for the condition characterized by central scalp hair loss that is now called “central centrifugal cicatricial alopecia” (CCCA) has evolved over time:
●1968 – The term “hot comb alopecia” is proposed by the authors of a published series of 51 African-American women with scarring alopecia involving the central scalp based upon a theory that permanent hair loss resulted from thermal damage to the scalp during use of a hot comb (a specialized metal comb that is heated and used to straighten hair) .