Central centrifugal cicatricial alopecia (CCCA) is the most common form of scarring alopecia in women of African descent, with prevalence estimates of 3–6% in affected populations. The condition begins as patchy thinning at the vertex that gradually expands outward (centrifugally), with progressive scarring that destroys follicles permanently. Like other scarring alopecias, early diagnosis matters because treatment can only halt progression, not reverse damage.

The pathophysiology remains incompletely understood. Historical theories about hair styling practices (hot combing, chemical relaxers) as the cause have been largely replaced by recognition that CCCA has underlying genetic susceptibility, with PADI3 gene variants identified as risk factors in 2019. Styling practices may modify expression but aren't the primary cause. The condition also occurs in women who have never used heat or chemical hair treatments, complicating earlier assumptions.

Treatment focuses on early recognition and active disease suppression. Topical and intralesional corticosteroids are first-line for inflammatory components. Doxycycline (anti-inflammatory dosing) has supporting evidence. Minoxidil for the androgenetic component that often coexists. Patient education about modifying excessive heat and tension styling helps but doesn't substitute for medical treatment. Hair transplant for established CCCA is technically possible in stable disease, but with lower graft survival than in non-scarring causes, making patient selection critical.