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Is a chronic progressive inflammatory scarring alopecia. It is the most common cause of scarring alopecia in women of African descent. Hair loss may start as breakage or change in hair texture on the central scalp and spread outward.  It can progress to patchy hair loss or large areas of balding.  It may or not be associated with itching, pain, and soreness. The exact cause of CCCA is unknown but a new study has identified a gene variant of peptidyl arginine deiminase 3, PADI3, present in approximately one-quarter of studied patients with CCCA. One study also demonstrated a 5-fold increase in the occurrence of uterine fibroids in women with CCCA.  It may be managed with anti-inflammatory medications (topical/ oral/ injections), minoxidil, avoidance of tension producing hairstyles, platelet rich plasma, and hair transplantation).

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References: 

- Callender VD, Lawson CN, Onwudiwe OC. Hair transplantation in the surgical treatment of central centrifugal cicatricial alopecia. Dermatol Surg 2014;40:1125-31. 

- Dina Y., Okoye G.A., Aguh C. Association of uterine leiomyomas with central centrifugal cicatricial alopecia. JAMA Dermatol. 2018;154(2):213–214

- Malki L, Sarig O, Romano MT, et al. Variant PADI3 in central centrifugal cicatricial alopecia. N Engl J Med. 2019;380:833-841

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Stages of CCCA: Olsen Et al, Dermatologic Therapy Volume 21, Issue 4, pages 264-267, 15 JUL 2008