Central centrifugal cicatricial alopecia

Central centrifugal cicatricial alopecia, or CCCA, is a scarring form of hair loss that begins at the center of the scalp and spreads outward, first documented in African American patients in the 1950s. Its exact cause is unclear, but it is thought to involve pressure or damage to the inner root sheath of the hair follicle that recruits inflammatory cells and leads to permanent scarring, likely from multiple contributing factors rather than one single cause. The condition typically begins in a person's twenties and progresses over 20 to 30 years, starting with itching, unusual sensations and tenderness before the scalp thins, loses hair follicles and can become shiny as it advances; while historically associated with hot-comb styling using heated petrolatum, it also occurs in people without that styling history, suggesting other hair care practices may play a role.