Last weekend I was at a book launch of a friend and bumped into an old friend from university, we exchanged pleasantries and soon began talking about hair. I was sad to learn she was suffering from Central Centrifugal Cicatricial Alopecia (CCCA). A type of hair loss common in black women. I encouraged her to see a Dermatologist versed in black hair and hair loss specifically, because success can really be dependent on how quickly treatment begins.
I sensed some reluctance, she had seen two Trichologists already, plus an NHS Dermatologist who she didn’t appear to rate much. I looked in her eyes and saw a little resignation and frustration, all I could mutter was “I know come great black dermatologist who are well versed in treating this”.
Coincidentally we had already contacted DR Adeola Balogun, a Board Certified Consultant Dermatologist and a Hair Transplant surgeon. Here is what she said about CCCA on our Instagram page.
So what is CCCA and why is it more common in Black Women.
Central Centrifugal Cicatricial Alopecia (CCCA) is more common in Black women because of a combination of genetics, environmental, and cultural factors.
PADI3 Gene Mutation: Research has identified mutations in a gene crucial for hair follicle structure as a potential genetic link to CCCA. This mutation is more prevalent in individuals of African descent and may predispose them to the condition .
Familial Patterns: Studies suggest that CCCA may run in families, with Black women who have the condition more likely to have a maternal grandfather with male-pattern baldness, indicating a possible hereditary component .
Chemical and Heat Styling: Practices like chemical relaxers, hot combs, and excessive heat styling can weaken hair and irritate the scalp, potentially triggering inflammation and scarring in genetically susceptible individuals. However, not all women who use these products develop CCCA, indicating that genetics play a primary role.
Traction from Hairstyles: Tight braids, weaves, and extensions can cause chronic tension on hair follicles, leading to inflammation and scarring. While traction alopecia is different from CCCA, prolonged tension may exacerbate underlying susceptibility.
Autoimmune Component: CCCA may involve an autoimmune response where the body attacks hair follicles, though this is not yet conclusively proven. Inflammation from other conditions (e.g., type 2 diabetes) might also contribute, as Black women with CCCA have higher rates of diabetes .
Fibroproliferative Tendencies: Black individuals are more prone to disorders involving abnormal scarring (e.g., keloids, uterine fibroids), which may explain the scarring mechanism in CCCA. A study found a five times increased risk of uterine fibroids in Black women with CCCA, suggesting shared pathways in fibrous tissue overgrowth.
Underdiagnosis: Many Black women initially consult hairstylists rather than dermatologists for hair loss, delaying medical intervention. Cultural stigma and lack of awareness about CCCA as a medical condition contribute to this gap . Please guys see someone and if your hairdressers brings it to your attention do not delay!
Healthcare Disparities: Limited access to dermatologists specialising in hair disorders, especially those familiar with Black hair textures, can prolong untreated inflammation and scarring . This is why our expert series is signposting you to the very best!
Hair as Identity: Hair holds significant cultural and personal value for Black women, leading to styling practices that may inadvertently stress follicles. The pressure to conform to Eurocentric beauty standards (e.g., straightening) historically increased reliance on damaging treatments . We need to do less! Way less!
CCCA’s higher prevalence in Black women stems from a complex interplay of genetics (PADI3 mutations), inflammatory responses, and cultural hair practices. While styling methods may contribute, genetic susceptibility is likely the primary driver, with environmental factors acting as triggers . Early diagnosis and gentle hair care are critical to managing progression.
So far in our expert series we have done two two amazing dermatologist! If you need help please get help!