CCCA in London — the scarring alopecia most common in Afro-textured hair
CCCA is the most common scarring alopecia in Black women. Early treatment saves follicles. Late treatment saves what's left.
Dr. Amara Okafor
Consultant Trichologist · Harley Street
In short
- Starts at the crown; spreads centrifugally.
- Predominantly affects women of African descent aged 30–55.
- Genetic component (PADI3 gene) plus tension-styling triggers.
- Treatment: doxycycline, topical steroid, minoxidil, tension reduction.
Central centrifugal cicatricial alopecia (CCCA) begins at the crown and expands outward. It's underdiagnosed — often mistaken for FPHL — because it can look similar in early stages. But CCCA scars, and FPHL doesn't. Getting it right matters.
How CCCA differs from FPHL
- CCCA: tender or itchy scalp; FPHL: symptom-free
- CCCA: loss of follicular openings on trichoscopy
- CCCA: peripilar white halo sign
- FPHL: miniaturisation without scarring
The London treatment protocol
Doxycycline (anti-inflammatory dose) 3–6 months. Potent topical steroid. Intralesional steroid at active edge. Topical minoxidil 5%. Radical reduction of tension styles (braids, wigs with pull, weaves) — non-negotiable during active phase.
Cultural sensitivity in the consult
A trichologist who tells a Black patient to 'just stop the braids' without a plan has failed. Wig alternatives, low-tension protective styles, and salon partnerships that understand CCCA exist across London — Afro-specialist salons in South and East London especially.
Diagnosing CCCA early is a specialty. Treating it well is a partnership.
Frequently asked
Common questions
Is CCCA reversible?+
Early — some regrowth possible. Established — arrest is the goal.
Should I stop wearing wigs?+
Not necessarily — low-tension wigs (silicone-grip, no glue) are fine. Aggressive braiding under wigs is not.
Is a transplant possible?+
Only after 2+ years of quiescence. Donor viability must be confirmed.
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