CCCA Treatment in Atlanta, GASlowing Central Centrifugal Cicatricial Alopecia and Protecting Remaining Hair

Early diagnosis and steady anti-inflammatory care to keep the hair you have.

Common In:
Adult women of African descent most often; men and teens can be affected too
Primary Causes:
Follicle inflammation and scarring, with genetic and hair-care factors
Treatment Time:
Visits of 30 to 60 minutes; injections every 4 to 8 weeks when needed
Results:
Itch and tenderness often ease in 2 to 3 months; scarred areas do not regrow
Woman with natural curly hair at a crown scalp exam for CCCA treatment with a dermatologist in Atlanta, GA
Close-up of thinning at the crown of the scalp from central centrifugal cicatricial alopecia at SOCAH Center Atlanta

What Is CCCA (Central Centrifugal Cicatricial Alopecia)?

Recognizing the Signs Early

Central centrifugal cicatricial alopecia (CCCA) is a scarring form of hair loss that starts at the crown or vertex of the scalp and slowly spreads outward in a circle. Inflammation around each hair follicle gradually replaces it with scar tissue, so hair that is lost to CCCA usually cannot grow back. It is one of the most common causes of scarring hair loss in women of African descent, and it also occurs in men, teens and people of other backgrounds.

CCCA often begins quietly. Many patients first notice breakage or shorter hairs at the crown, followed by thinning, itching, tingling or tenderness. Because curly and coily hair can hide early thinning, and because the crown is hard to see in a mirror, diagnosis is often made years after symptoms start.

The goal of CCCA treatment is to calm the inflammation, stop the spread and protect remaining follicles. Explore our hair and scalp conditions to compare CCCA with related diagnoses.

Medically reviewed by Dr. Nikki D. Hill, MD, FAAD. Last updated: October 2026.

Why CCCA Happens

Understanding the Root Causes

01The Science

In CCCA, the inner root sheath of the hair follicle breaks down early, a change called premature desquamation. Immune cells then gather around the upper follicle, and over months to years that inflammation turns into fibrosis. Once its regenerating cells are destroyed, the follicle closes for good.

Research points to more than one cause. Variants in a gene called PADI3 have been linked to CCCA, and the condition can run in families. Hair-care practices that add tension, heat or chemical stress may worsen it in people who are already prone, which is why CCCA can overlap with traction-related hair loss; our dermatologist article on whether traction alopecia can be reversed explains where the two differ. The American Academy of Dermatology overview of CCCA stresses that starting treatment early can keep CCCA from spreading, and the Skin of Color Society supports research and education on hair and scalp conditions across all communities.

At SOCAH Center, CCCA care sits within our medical hair loss treatment program, which pairs anti-inflammatory therapy with a plan to protect and support remaining hair.

02Diagnosis at SOCAH

How We Diagnose CCCA

Why an Early Biopsy Matters

Your visit starts with a history of symptoms, styling habits and family history, followed by a full scalp exam and trichoscopy. A gray-white halo around remaining hairs at the crown is a classic clue. Because CCCA can look like female pattern hair loss, traction alopecia or discoid lupus of the scalp, a small punch biopsy from the edge of the thinning area confirms the diagnosis and shows how much scarring is present. Blood work may check iron, thyroid and blood sugar.

Treatment follows the stage of disease. Active CCCA is usually treated with a strong topical steroid, steroid injections into the affected scalp and, for many patients, an oral anti-inflammatory antibiotic such as doxycycline. Topical minoxidil can help remaining hair once inflammation is under control. As an adjunct for follicles that are still alive, PRP therapy for hair loss uses your own growth-factor-rich platelets to support thicker growth. PRP does not reverse scarring and is added only after inflammation is controlled.

Medical hair loss visits and biopsies are often covered by insurance. For PRP, which is typically self-pay, monthly payment plans through CareCredit and Cherry are available.

What Makes CCCA Worse?

CCCA has no single cause, but these factors can speed it up or make it harder to control.

  1. 01Family HistoryCCCA often runs in families, and some patients carry PADI3 gene variants that affect hair shaft formation.
  2. 02Tension on the ScalpTight braids, weaves and extensions that pull at the crown can add stress to already inflamed follicles.
  3. 03Heat and ChemicalsFrequent hot tools and chemical relaxers may irritate a scalp prone to CCCA, though the link is still studied.
  4. 04Delayed DiagnosisEach year of active inflammation without treatment allows more follicles to scar and close permanently.
  5. 05Metabolic HealthType 2 diabetes and related metabolic changes have been associated with a higher risk of CCCA.
Calm, modern hair loss consultation room at SOCAH Center in Atlanta, Georgia, where CCCA patients are seen

Why Choose SOCAH Center for CCCA Care in Atlanta, GA

Dr. Nikki D. Hill, MD, FAAD, a board-certified dermatologist nationally recognized for diagnosing and treating medical hair loss disorders, leads every CCCA plan for patients from Atlanta, Decatur, Stone Mountain and Tucker. Tyrone Nieves-Martinez, MSHS, PA-C, also sees patients for hair loss evaluations and PRP.

Scarring Alopecia Focus
Medical hair loss is the core of our practice, so CCCA is often recognized at its earliest, most treatable stage.
Biopsy-Guided Care
Trichoscopy and biopsy confirm CCCA and stage it, so treatment matches the activity of your disease.
Styling Without Guilt
We give practical, judgment-free styling advice that fits your hair texture, lifestyle and culture.
Medical Hair Salon
Our dermatologist-supervised salon team helps you care for fragile hair gently between medical visits.
Comparison chart of CCCA treatment options including steroids and PRP at SOCAH Center in Atlanta, GA

CCCA Treatment Options

Anti-inflammatory therapy comes first; regrowth support is added for follicles that are still alive.

Care ProgramTreatment OptionBest ForResults TimelineMaintenance
Hair Loss TreatmentHigh-potency topical steroidActive itch, tenderness and early CCCASymptom relief in 4 to 8 weeksDaily, then tapered
Hair Loss TreatmentIntralesional steroid injectionsInflamed edges of the thinning areaCalming in 1 to 3 monthsEvery 4 to 8 weeks while active
Hair Loss TreatmentOral anti-inflammatory antibioticModerate or spreading diseaseBuilds over 3 monthsSeveral months, then reassessed
Hair Loss TreatmentTopical minoxidilSupporting remaining hairThicker hair in 4 to 6 monthsOngoing for lasting benefit
PRP for Hair LossPlatelet-rich plasma injectionsLiving follicles once inflammation is calmGradual change over 3 to 6 monthsMonthly series, then periodic boosters

Signs You May Have CCCA

If any of these sound familiar, an early dermatology visit gives you the best chance of keeping your hair.

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  • Crown Breakage

    Hairs at the top of your head break off short or will not grow past a certain length, even with gentle care.

  • Spreading Thin Spot

    A thinning area at the crown slowly widens over months or years in a circular pattern.

  • Itch or Tingling

    Your crown itches, burns, tingles or feels tender, even when your scalp is clean and moisturized.

  • Shiny Scalp Skin

    The scalp in the thinning area looks smooth and shiny, with fewer openings where hairs used to grow.

  • Stylist Notices First

    Your stylist or barber points out thinning at the crown before you have noticed it yourself.

Related Treatment

PRP for Hair Loss

Concentrated platelets from your own blood, placed where follicles are thinning, for every hair type.

  1. Your Own Blood
  2. No Surgery
  3. Little Downtime
Learn More

Frequently Asked Questions

Can hair grow back with CCCA?
Hair can sometimes regrow in areas that are inflamed but not yet scarred, which is why early treatment matters. Where follicles have already closed and the scalp looks smooth and shiny, regrowth is unlikely. The main goal of CCCA treatment is to stop the spread and keep the hair you have, and many patients see thicker remaining hair with steady care.
Is CCCA caused by relaxers or braids?
Relaxers and braids alone do not cause CCCA, but they may worsen it in people who are prone. Genetics, including PADI3 gene variants, play a major role, and CCCA also appears in people who have never used chemical or tension styles. We help you adjust styling so it is gentler on the crown without asking you to give up the looks you love.
How is CCCA different from traction alopecia?
CCCA starts at the crown and spreads outward because of inflammation inside the follicle, while traction alopecia usually affects the hairline and edges from repeated pulling. The two can occur together. A scalp exam and biopsy show which one, or both, is present.
Does PRP work for CCCA?
PRP may help as an add-on for follicles that are still alive, but it is not a stand-alone treatment for CCCA. Research is still limited. PRP is added only after inflammation is controlled with medical therapy, since it cannot reopen follicles that have already scarred. Individual results vary.
Can men get CCCA?
Yes, men can develop CCCA, although it is diagnosed far more often in women. In men it may be mistaken for male pattern baldness because both affect the crown. A scalp exam with trichoscopy and, when needed, a biopsy tells the two apart so treatment targets the right condition.
How long does CCCA treatment take?
CCCA treatment is long term, usually lasting many months to years. Itching and tenderness often improve within 2 to 3 months, while the effect on hair density takes 6 months or more to judge. Many patients later move to a lighter maintenance plan.
Location2296 Henderson Mill Rd, Suite 300Atlanta, GA, 30345
Emailinfo@socahcenter.com
Phone(404) 474-2301

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Scientific References

  1. Jackson et al., J Am Acad Dermatol. (2024). Treatment for central centrifugal cicatricial alopecia-Delphi consensus recommendations. PMID: 38341148.
  2. Whiting et al., Dermatol Ther. (2008). Central centrifugal cicatricial alopecia. PMID: 18715297.
  3. Lawson et al., Dermatol Clin. (2021). Central Centrifugal Cicatricial Alopecia: Challenges and Treatments. PMID: 34053593.
  4. Jackson et al., J Am Acad Dermatol. (2023). Central centrifugal cicatricial alopecia in males. PMID: 37495175.
  5. Pirmez, J Am Acad Dermatol. (2023). The dermatoscope in the hair clinic: Trichoscopy of scarring and nonscarring alopecia. PMID: 37591567.