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What is CCCA (Central Centrifugal Cicatricial Alopecia)?

What is Central Centrifugal Cicatricial Alopecia: CCCA is a type of scarring alopecia hair loss that occurs almost exclusively in women of African descent, and can easily lead to permanent hair loss. CCCA is a major cause of hair loss for many Black women [1].

Hair loss from CCCA begins at the center top of the head and progresses in an ovular or circular area outwards. “Centrifugal” refers to the circular pattern of hair loss commonly seen in patients. CCCA is known to progress gradually but can be aggressively progressive for some.

During its later stages, CCCA can lead to permanent hair loss due to scarring that happens at the follicular level. The “cicatricial” categorization of CCCA originates from the scarring that happens at the hair follicles. Due to the scarring nature of CCCA, it is categorized as scarring alopecia.

General symptoms of CCCA can be quite uncomfortable:

  1. Partial to permanent hair loss
  2. Scarring at the hair follicles
  3. Scalp itching
  4. Scalp burning

Other names for CCCA include:

  1. Hot comb alopecia
  2. Follicular degeneration syndrome

CCCA: Central Centrifugal Cicatricial Alopecia Patient Example

CCCA Patient Example 1* Notice the centrifugal, or circular, ovular spreading of scarring hair loss which is the main characteristic of CCCA.


Causes of CCCA (Central Centrifugal Cicatricial Alopecia)

Strong heat or chemical treatments to the hair, as well as tight hairstyles, can all aggravate the scalp, and possibly begin the onset of CCCA. Therefore, it is best to avoid hot rollers, chemical relaxers, and heat-related hair or scalp treatments, especially for those with a family or genetic history of CCCA.

CCCA is generally accepted as a hereditary condition [2], but is also known to be exacerbated by the following factors:

  • Frequent use of heated products on hair or scalp: thus the term “hot comb alopecia”
  • The use of tight hairstyles: overly tight braids, weaves, or extensions
  • Use of chemical relaxers or other harsh chemically-based hair products such as hair dyes
  • General use of tight or hot rollers
  • Excessive pulling from brush or comb use


Preventing CCCA is highly recommended as its prevention is the best cure. To do so, it is best to avoid tight braids, weaves, or dreadlocks.


Who is affected by Central Centrifugal Cicatricial Alopecia?

CCCA is generally accepted to affect mostly Black women over the age of 30. CCCA is known as a major factor of hair loss for Black women due to the more common use of tight hairstyles that put tension or pull on the scalp, or due to the harsh products used by women with Afro-textured hair. Just recently, there has been a possible genetic basis for CCCA discovered [3].  

Diagnosing CCCA – Dr. U Skin & Hair Clinic

If you suspect you have CCCA, it is best to treat it early.

First begin with a licensed dermatologist who is an expert in CCCA diagnosing and treatment, such as Dr. Sanusi Umar, MD.

Diagnosing CCCA will be done based on the visual examination of the patient’s scalp, or by using a special handheld magnifying lens instrument – known as dermoscopy or trichoscopy. To finalize or confirm the diagnosis, however, may require a biopsy.

Using trichoscopy, the dermatologist would be directed to the best spot on the scalp from which the biopsy should be extracted.

This biopsy process entails the extraction of only a small piece of skin between 2-4mm in size after numbing the area with a local anesthetic, similar to what you would find at the dentist.

Once extracted, the biopsy specimen is further studied in fine detail under the microscope by the dermatologist or dermatopathologist who searches for key features to confirm whether or not the patient has CCCA.

A Novel Approach to CCCA – No Injections, Natural Treatment by Dr. Umar

Although CCCA is known as a stubborn and difficult condition to treat, often failing improvement even with the use of drugs and pharmaceuticals, such as steroid creams, topicals, and injections, Dr. Umar has had extensive success in reducing symptoms for his CCCA patients, with results such as exceptional improvement in hair growth, hair health, as well as the reduction of other CCCA-related symptoms.

Dr. Umar does this through various original treatment procedures he personally developed. More information on his natural product line Dr.UGro Gashee can be found below.

Schedule a consultation with Dr. Umar if you believe that you might have CCCA, other forms of alopecia or hair loss, or any other skin or hair-related issues.


CCCA Histology Photo*


Current Treatments for Central Centrifugal Cicatricial Alopecia

Most dermatologist treatment for CCCA includes oral, topical, or injectable steroids, as well as a range of other pharmaceuticals or drug-based products.

These pharmaceutical or drug-based treatments generally work by reducing inflammation and suppressing the immune system to prevent the destruction of healthy follicles. For advanced stages of CCCA, however, anti-inflammatory medications are often used. Certain families of oral antibiotics (such as tetracycline, doxycycline, and minocycline) can potentially lessen inflammation and prevent further hair loss.

There are also other medications that have been tried for CCCA, including powerful immunosuppressants and modulators such as hydroxychloroquine, Tacrolimus, cyclosporine, and mycophenolate. These treatments are usually combined with procedures involving platelets or light. Many of these treatments show variable and inconsistent response rates.

As a final key takeaway, it is important to note that these drug-based or pharmaceutical treatments do not cure CCCA. They only maintain its symptoms temporarily. Therefore, these treatments are often used chronically – such as in the case of steroid topical injections, which involve ongoing steroid injections into the patient’s scalp to temporarily minimize symptoms. Unfortunately, for reasons such as patient frustration, as well as unwanted side effects or complications, these treatments are often discontinued.

In such a situation, finding a treatment for CCCA that works for the long-term, without side effects, and is easy to use, would be a significant improvement for CCCA treatments.

The Dr. U Skin & Hair Clinic Difference: How Does Dr. U Treat CCCA?

Over years of experience in managing hair conditions as a world-renowned hair expert, and having used all the conventional approaches for treating CCCA, Dr. U has created his own original natural botanical products for treating CCCA.

Instead of using steroid scalp injections, topicals, and other drugs, Dr. U has been able to help save his patients from the pain and discomfort associated with those treatments by using his self-formulated natural hair product line, Dr.UGro Gashee.

Whereas other general treatments have shown little to no improvement for CCCA symptoms,
Dr. U’s self-formulated Gashee has recently been reported as the first botanical to show a positive response toward CCCA.

Dr.UGro Gashee – CCCA Natural Alternative

GASHEE Natural Hair Products have been recently published in a peer-reviewed medical journal, reported as the first botanical with a positive response towards CCCA.

Gashee is a popular brand of hair care products that utilize natural ingredients to nourish the hair and scalp while effectively maximizing hair health for growth and strength.

Dr.UGro Gashee products are formulated with natural ingredients including necessary vitamins for hair health. Some of Gashee’s quality natural ingredients include a proprietary blend of green tea, cinnamon, celery, grape seed, rosemary, aloe vera, pumpkin seed, and more.

In addition to these botanical ingredients, Gashee uses hyaluronic acid, zinc, iron, and other crucial vitamins to reduce inflammation, boost growing hair health, provide moisture, and repair damaged hair via healthy growth. The botanical lotion and pomade work topically to fight various forms of alopecia and improve hair and scalp health while the oral botanical supplements assist hair health through internal means. 

In a recently published peer-review medical journal, Dr.UGro Gashee hair products have been reported as the first botanical that showed a positive response towards CCCA symptoms, including hair loss. In the study, several women who had a history of CCCA, previously treated with pharmaceuticals and drug-based means such as topical and injectable steroids with little to no positive results, have shown positive responses when using Gashee natural hair products. This is a significant finding, as the role of natural products in the future of CCCA treatment can prove to have massive potential due to their often more favorable side effect profiles, better suited for long-term patient use.

View Full Gashee Publication on CCCA: First Natural Botanical to Show Positive Response Towards CCCA


What are botanicals?

“Botanical” simply refers to products derived from plants. The utilization of natural ingredients from plants often creates a healthier, more effective product. Botanicals are particularly known for naturally-occurring healing and medicinal properties that are easy for the body to absorb. Dr.UGro Gashee uses botanicals in all products, providing naturally-derived lotions, pomades, and supplements. These products created or cold-extracted from plants promote improved holistic wellness and hair health, helping fight symptoms of CCCA in a way that is safe, natural, and proven effective. 


Before and After – CCCA Gashee Published Patient Results

The pictures below show the before and after photo results of one of the many patients involved in the Gashee study published in the peer-reviewed medical journal Clinical Cosmetic and Investigational Dermatology. This patient, as well as many others who participated in the study, was able to recover a large portion of hair loss in areas of balding areas of hair loss through daily use of Gashee topical and oral supplements.

CCCA Patient Treated Using GASHEE Topical & Oral Supplements twice daily – Natural Hair Growth Results V1*
CCCA Patient Treated Using GASHEE Topical & Oral Supplements twice daily – Natural Hair Growth Results V2*


Never before has there been a natural treatment that has been reported to show a positive response toward CCCA.

If you are interested in Dr. UGro Gashee products, visit our Gashee product page using the shop Gashee button link below:


CCCA Frequently Asked Questions

What is Scarring Alopecia?

  • Scarring Alopecia, also called cicatricial alopecia, refers to a form of alopecia in which hair follicles are destroyed via scarring, thus resulting in permanent hair loss.

Is Scarring Alopecia the same as CCCA?

  • Scarring Alopecia refers to the scarring nature of CCCA in the sense that this condition scars the hair follicles, creating permanent hair loss.
  • The “central” and “centrifugal” part of CCCA refers to the outwardly circular or ovular progression of the CCCA hair loss pattern.
  • There are other types of scarring alopecia, but CCCA is one of the most common, if not most common type of scarring alopecia.

Is Alopecia a diagnosis?

  • Yes. Alopecia is diagnosable by a licensed dermatologist and is recommended to do so to find the best treatment option.

Can CCCA be cured or reversed?

  • If caught and treated within enough time, symptoms of CCCA can be reduced to the point where its effects may be noticeably reduced, but left untreated and allowed to progress to its later stages, severe follicular damage from CCCA can be irreversible – leading to permanent hair loss.

Can I treat CCCA with hair transplantation?

  • With the right experienced hair surgeon, hair transplantation is possible. Be sure to find a reliable doctor who specializes in covering scars and restoring damaged scalps such as Dr. U if you are looking for hair transplantation to help with your CCCA-related hair loss as this procedure is different than regular hair transplantation.

Are platelet-based treatments viable for CCCA?

  • Some studies show that platelet-based treatments may help in combating CCCA symptoms, but treatment results may vary. Be sure to speak with your dermatologist in detail to consider the options best for you.

Can I use Gashee or any other botanicals to treat my scarring alopecia or CCCA on my own?

  • If you suspect you have scarring alopecia, you must first consult a dermatologist to get a proper diagnosis and then follow their recommendation on how best to treat the condition.
  • You can complete a free consultation for your hair loss with board-certified dermatologist Dr. Sanusi Umar by using this link: or using the free consultation button below.


If you suspect you have CCCA or any other hair, or skin condition and would like to consult Dr. Umar who has had a great deal of experience in treating CCCA patients successfully, please do so using the free consultation button below:


  1. Central Centrifugal Cicatricial Alopecia (CCCA) | Hair Loss in Black Women. (2015, March 13). Skin of Color Society.
  2. Central centrifugal cicatricial alopecia | DermNet NZ. (n.d.).
  3. Malki, L., Sarig, O., Romano, M.-T., Méchin, M.-C., Peled, A., Pavlovsky, M., Warshauer, E., Samuelov, L., Uwakwe, L., Briskin, V., Mohamad, J., Gat, A., Isakov, O., Rabinowitz, T., Shomron, N., Adir, N., Simon, M., McMichael, A., Dlova, N. C., & Betz, R. C. (2019). Variant PADI3 in Central Centrifugal Cicatricial Alopecia. New England Journal of Medicine, 380(9), 833–841.
Dr. Sanusi Umar, MD

Sanusi Umar MD, FAAD is a board certified Dermatologist by the American board of dermatologists. Before then he was board certified by the American board of internal medicine. He is on faculty at both UCLA and Harbor-UCLA dermatology divisions. He is the head of the scalp and hair disorders section of the Harbor-UCLA where he teaches dermatology residents. Dr Umar has published several articles in peer review journals in the field of dermatology and the subject of hair disorders and management in general. His areas of research include hair loss treatment using natural non pharmaceutical methods, acne keloidalis nuchae, novel hair loss treatment pathways as well as in the field of hair transplantation where he pioneered the follicular unit excision - FUE methods of hair surgery, body hair transplantation and African hair type transplantation. He holds several patents both in the United states and worldwide. He is the owner of Dr U Hair and Skin Clinic, Finetouch Laboratories Inc which is the maker of an all natural hair health product line as well as Dr U Devices Inc which is a maker of FUE hair transplantation and other surgery devices

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