CCCA (Central Centrifugal Cicatricial Alopecia) and Hair Transplants

Written by the AfroHairClinicTurkey editorial team, drawing on the clinical experience of our medical team · Last updated September 3, 2026 · How we write and check this

On this page 6 sections
  1. Thinning at the crown: what puts CCCA in the picture
  2. What CCCA Is, and what it does to the follicle
  3. What Causes It — and What the Evidence Says Does Not
  4. What Treatment Can and Cannot Do
  5. The Transplant Question
  6. If This Sounds Like You

If you have been told that a hair transplant will fix CCCA, this page is the one to read before you pay for anything. The honest answer is that for most people with it, at the point they are asking, the answer is no — and the reason is worth understanding rather than taking on trust.

Thinning at the crown: what puts CCCA in the picture

Most people who notice hair loss at the crown are not looking for a disease name. They see more scalp in a photograph taken from behind, or a part that has widened at the top of the head, and they want to know what it is.

Crown thinning has more than one cause, and the common one — androgenetic loss, which thins hair gradually without destroying the follicle — is genuinely the most likely answer for many people. This page is about the possibility that is rarely mentioned to the people it happens to most, because getting this one wrong is expensive in a way that getting the common one wrong is not.

What should raise as a question rather than settle it: thinning that started at the crown and spread outward rather than receding from the front; a scalp that is tender, itchy or burning; hair that comes out and does not come back in the same place; and being a woman of African ancestry, which is the group in which it is most often seen.[1] None of those is a . All of them are reasons to have the scalp examined by someone who can take a biopsy, rather than to start pricing grafts.

A head seen from above with a small circle at the crown, dashed lines radiating outward from it, and remaining follicles marked only around the outer scalp.
Outward from the centre rather than backward from the front — the direction is what raises the question.

The distinction matters because the two answers lead to opposite places: androgenetic thinning leaves a follicle that is still alive, and a does not. That is why the rest of this page is about evidence and biopsy rather than about coverage — and why, if the question in your head is how many grafts a crown would take, that arithmetic only begins to mean something after this question is answered.

If you are not sure yet whether the crown is even where yours started, the three patterns are laid out side by side here — edges, crown, or everywhere at once.

What CCCA Is, and what it does to the follicle

Central centrifugal cicatricial alopecia is the most common form of scarring alopecia among women of African ancestry.[1] It usually starts at the crown and spreads outwards — which is what “centrifugal” describes — and in the same Cape Town population study that measured traction alopeciaTraction alopecia Hair loss caused by sustained tension on the follicle, concentrated at the hairline and temples., it was found in 2.7% of the women examined, rising to 6.7% of women over fifty.[2]

The word doing the heavy lifting is cicatricial: scarring. In non-scarring hair loss the follicle is still there and the question is whether it can be persuaded to work again. In scarring alopecia the follicle itself is lost and replaced by scar tissue. That distinction is the whole of this page, because it changes what treatment can achieve and it changes what surgery is being asked to do.

What Causes It — and What the Evidence Says Does Not

For years the assumption was that CCCA came from relaxers and hot combs. A case-control survey of 101 African American women found no correlation between either of those and the development of CCCA, contrary to what had long been assumed.[3] That is worth sitting with if you have spent years being told your hair loss was your own fault for relaxing your hair.

The same survey did find a strong association between CCCA and sewn-in weaves, and between CCCA and cornrows or braids using artificial extensions — and women with CCCA were more likely to report pulling and tenderness from those styles.[3] An association is not proof of cause, and this one runs alongside a separate, well-documented fact: traction induces inflammation and follicle damage, and the risk rises with styles that hurt.[4,5]

There is a genetic thread as well. Variants in the PADI3 gene, which encodes a protein needed to build the hair shaft, have been associated with CCCA — but the association does not explain every case, and most patients studied carried no such variant.[1]

What Treatment Can and Cannot Do

Here is the part most pages skip: there is no established standard of care for treating CCCA. A 2024 Delphi panel of twenty-seven hair-disorder dermatologists reached strong consensus on only twenty of the seventy statements they considered.[6] That is not a gap in this page. It is the state of the field, and anyone presenting a confident protocol should be asked what they are basing it on.

What that does not mean is that nothing is worth doing. Scarring alopecia is progressive while it is active, so the realistic goal at that stage is to stop the loss spreading and protect what is still there — which is a dermatological question, answered by someone who can examine the scalp and, where needed, biopsy it. It is not a question a website can answer, and it is not one a surgical is designed to answer either.

Afro Hair Lab

Scarring, and What It Does to the Transplant Question

The crown from above. Spread the affected area, decide whether the disease is still working, and then try placing grafts into it.

Is the disease still working?

The dashed ring is where the disease is working. Inside it the follicles are not dormant — they have been replaced, which is what the word scarring is doing in the name.

What the register holds behind this. Central centrifugal cicatricial alopecia is the most common form of scarring alopecia among women of African ancestry[1] There is no established standard of care for treating it: a 2024 Delphi panel of twenty-seven hair-disorder dermatologists reached strong consensus on only twenty of the seventy statements they considered[6] And transplantation has been reported as safe and effective in CCCA in two published cases, only where the disease was end-stage and a scalp biopsy showed no remaining inflammation[7]

What this model does not do

  • It cannot tell you which state you are in. Nobody can, from above — that is the entire point of the burnt-out setting looking so much like the active one.
  • It is not a diagnosis, and it does not say whether a transplant is right for you. It shows what the published evidence does and does not cover.
  • Nothing about you is measured or sent anywhere. It runs in your browser.

The model above belongs to the Afro Hair Lab. Like the rest of them it exists to make a mechanism visible, not to tell you which condition you have.

The Transplant Question

has been reported as safe and effective in CCCA — but only in two published cases, and only where the disease was end-stage and a scalp biopsy showed no remaining inflammation.[7]

Read that carefully, because it carries three conditions and every one of them matters:

  • Two cases. Not a series, not a trial. Two. That is the published basis for the entire idea, and it is a thin one.
  • End-stage. Meaning the disease had burned out, not that it was being managed.
  • A biopsy showing no remaining inflammation. And if all three of those are satisfied, the question that follows is a question of area and arithmetic rather than of hope — what a graft number actually covers is worked through in the Lab. Not an opinion that it looked quiet. A biopsy.

So the honest position is this. If your CCCA is active, transplanting into it is placing healthy follicles into ground that is still destroying follicles. If it is genuinely burnt out and a biopsy confirms it, surgery becomes a conversation worth having — on evidence that is real but very limited, which you are entitled to know before you consent to anything.

What we would want to see before discussing surgery with anyone who has CCCA

  • A dermatological diagnosis, not a surgeon’s impression
  • A scalp biopsy, and a clinician who has read it
  • Evidence the disease is no longer active
  • A frank conversation about the two-case evidence base above

A clinic that will book you without those is not being generous with your time. It is skipping the step that decides whether the operation can work at all.

If This Sounds Like You

Crown thinning that spreads outwards, sometimes with tenderness, itching or a burning feeling, in a person of African ancestry, deserves a dermatologist before it deserves a price list. Getting that appointment is not a delay in your hair transplant journey; it is the thing that determines whether a transplant is part of the journey at all.

We publish what we can prove and withhold what we cannot — including about ourselves. If you want to see how that works, the verification page lists everything we hold, everything we are still waiting on, and the sources behind each claim. The terms on this page are defined in the glossary, and every study cited above is listed with it.

Clinical references

  1. Malki L, Sarig O, Romano MT, Méchin MC, Peled A, Pavlovsky M, et al. Variant PADI3 in Central Centrifugal Cicatricial Alopecia. The New England journal of medicine. 2019;380(9):833-841. view source →
  2. Khumalo NP, Jessop S, Gumedze F, Ehrlich R. Hairdressing and the prevalence of scalp disease in African adults. The British journal of dermatology. 2007;157(5):981-8. view source →
  3. Gathers RC, Jankowski M, Eide M, Lim HW. Hair grooming practices and central centrifugal cicatricial alopecia. Journal of the American Academy of Dermatology. 2009;60(4):574-8. view source →
  4. Mirmirani P, Khumalo NP. Traction alopecia: how to translate study data for public education—closing the KAP gap? Dermatol Clin. 2014;32(2):153-61. view source →
  5. Haskin A, Aguh C. All hairstyles are not created equal: What the dermatologist needs to know about black hairstyling practices and the risk of traction alopecia (TA). Journal of the American Academy of Dermatology. 2016;75(3):606-611. view source →
  6. Jackson T, Sow Y, Dinkins J, Aguh C, Omueti Ayoade K, Barbosa V, et al. Treatment for central centrifugal cicatricial alopecia-Delphi consensus recommendations. Journal of the American Academy of Dermatology. 2024;90(6):1182-1189. view source →
  7. Callender VD, Lawson CN, Onwudiwe OC. Hair transplantation in the surgical treatment of central centrifugal cicatricial alopecia. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. 2014;40(10):1125-31. view source →

References are checked on the dates recorded in our evidence library. If a source has been superseded, tell us and we will update it.