As Devin Beaford sat through her first round of scalp injections, the pain of a long needle repeatedly piercing the left side of her head was the first real indication that her hair loss journey would not be easy. “I literally left the doctor's office in tears because I was like, ‘Am I going to lose all my hair?’” recalls Beaford, now 30. “It was a very big what-if, unknown situation.”
Beaford, a Black woman in Philadelphia, has been navigating hair loss for over a decade. She first observed a sparse spot on her scalp behind her left ear when she was 19. “I noticed it was thinning, but it wasn't very noticeable to where I thought something bad had happened,” she says. Initially, she thought it might be traction alopecia, a common form of hair loss caused by prolonged tension on the scalp. But the problem area got worse over the next seven years. The thinning patch had grown larger, and increased itching and soreness in that area set off alarm bells for her.
“My hair was not even an inch off my head and in some spots completely bare,” says Beaford. “I was like, ‘Okay, something's wrong.’” Something was, indeed, wrong. During a December 2021 appointment with Philadelphia-based board-certified dermatologist Michelle Weir, Beaford underwent a biopsy (in which a portion of her scalp was removed to further examine the hair follicles up close), which confirmed her condition: central centrifugal cicatricial alopecia (CCCA).
The Causes of CCCA
Central centrifugal cicatricial alopecia is most commonly seen in women of African descent, though it has been reported in men and other races. It typically starts at the crown of the scalp and spreads outward. The word “cicatricial” comes from the Latin word for “scar,” which presents in CCCA as hair follicles that have been replaced by scar tissue.
“In CCCA, there is a process that causes fibrosis, or scarring, that destroys the hair follicles,” explains Temitayo Ogunleye, a board-certified dermatologist in Philadelphia. “So any hair loss that occurs is permanent.”
In its early stages, CCCA can be misdiagnosed as androgenetic alopecia because the two conditions can look very similar, says Yolanda Lenzy, a board-certified dermatologist in Chicopee, Massachusetts. Whereas androgenetic alopecia is characterized by the shrinking of hair follicles, which leads to thin, barely noticeable hair, the key indicators of CCCA are inflammation and damage to the follicles.
“Why do I have CCCA?” is one of the most common questions Dr. Lenzy gets from her patients. It's a question that, right now, doesn't have a concrete answer. The exact cause of this form of alopecia remains unknown, but as with many complex conditions, it’s usually multifactorial, she says. This type of hair loss was once referred to as “hot-comb alopecia” due to a presumed link between CCCA and heat straightening, but research has evolved.
While certain hair-care practices common among Black women—including chemical relaxers, braids, sew-ins, and locs—can cause extreme scalp tension and may trigger scarring in the crown area and lead to hair loss, Dr. Lenzy emphasizes that these practices are not the sole cause. “It's not just something that people are causing themselves with traumatic hair-care practices,” she says. “There are people who wear their hair in very low-manipulation styles, and yet they still get an expansion of this condition.”
Increased research into CCCA is revealing that "there is a definite genetic component of risk for the condition," says Amy McMichael, a board-certified dermatologist in Winston-Salem, North Carolina. "For those of us who see many women of color with hair loss, the clinical patterns seem to suggest that CCCA is quite common in families," she tells Allure.
Dr. McMichael, who chairs the dermatology department at Wake Forest Baptist Medical Center, was one of the primary investigators on a study into CCCA, with its findings published in the New England Journal of Medicine in 2019. That study concluded that mutations in gene PADI3, which is essential to how the hair follicle forms, were associated with CCCA.
Several of Dr. Lenzy’s family members—including her mother, sister, and aunts—have been affected by this form of alopecia for decades. “Back in the day when my mom was diagnosed with [CCCA] years ago, doctors were saying, ‘Oh, it's because of your choices, your hair-care practices,’” says Dr. Lenzy. “But now we know it's bigger than that.”
How CCCA Is Treated
CCCA typically occurs in the crown area, though some patients may develop patches across the scalp. The location of Beaford’s hair loss, on the side of her head, is one of the more rare examples. Though her hair loss was in a place that she could more easily conceal, it did not make Beaford’s CCCA diagnosis and treatment plan any less daunting.
CCCA is a chronic condition without a cure, says Dr. Lenzy. Flare-ups of inflammation can occur throughout the patient’s lifetime, so managing it takes long-term commitment on their part.
Treatment for CCCA begins by stopping the inflammation. Dermatologists regularly prescribe topical steroids in the form of ointments, creams, or gels that are applied to the scalp for their anti-inflammatory properties. Beaford began applying topical steroids immediately after diagnosis. Next, for deeper penetration into the scalp, her dermatologist moved to steroid injections, which were initially administered once a month for eight months.
In recent years, doxycycline, an antibiotic, has emerged as another option in the management of CCCA. In an analysis published in 2024, researchers found that using a low dose of doxycycline combined with a steroid regimen in the treatment of CCCA improved hair regrowth. Says Dr. Lenzy, “That has been a great paper to have in our arsenal to share with patients, to explain why we use a low dose of an antibiotic, even though [CCCA] is not an infection.”
Another newer treatment for CCCA that shows promise is metformin, an anti-diabetic medication. A small 2024 study found that low-dose metformin led to evidence of regrowth in CCCA patients and suppressed fibrosis markers.
Dr. Ogunleye stresses the importance of early intervention in treating CCCA. “Once a hair follicle is destroyed, we can't reverse that scarring process,” she explains. “The primary goal of treatment for CCCA is to stop the process [of hair loss], or halt the progress [of hair loss], and that may or may not include regrowth of hair.”
To improve the chances of hair regrowth in affected areas where severe scarring has not occurred, Dr. Ogunleye and Dr. Lenzy both add topical minoxidil, the active ingredient in Rogaine, to patient treatment plans. Supplements like Nutrafol and Viviscal Pro may also be used to aid in the growth and thickness of the hair, though the research on supplements is less conclusive for CCCA. (And you should always consult a board-certified dermatologist before starting a supplement treatment plan, even if they’re available over-the-counter.)
There are also in-office treatments patients can try for hair regrowth, including platelet-rich plasma, or PRP, injections, in which platelets are injected into the scalp at the level of the hair follicles to assist in hair-growth stimulation. Another advanced treatment is laser-assisted growth-factor delivery, in which lasers are used to open the scalp’s pores to enhance the absorption of topical growth factors. However, both of these procedures are variable in their success rate, Dr. Lenzy notes, and shouldn’t be considered first-line treatments.
The Cost of Treating CCCA
Dr. Lenzy says she's seen a lot of women become defeated after diagnosis, thinking they’ll have to come up with hundreds of dollars for advanced treatment. While treating any chronic condition can become expensive, the initial steps to combat the inflammation CCCA causes are often quite affordable.
“One of the reasons I didn't go to the dermatologist in the beginning was because I thought it was going to be a lot more expensive,” Beaford says. “I still kick myself. I'm like, ‘Girl, what were you doing?’”
Beaford’s insurance has helped her keep the treatment costs manageable; much of her care is covered, and she is left with affordable copays. She now regularly applies a foam version of minoxidil, which ranges between $30 and $80 for a multi-month supply. Her topical anti-inflammatory treatment, clobetasol, is covered by insurance and requires only a small out-of-pocket payment.
After three years of treatment, a roller-coaster of emotions, and many tearful updates shared on social media, Beaford finally reached a major milestone: She no longer needed scalp injections. It felt like a turning point in her CCCA journey, but the relief was short-lived; months later, in early 2025, the inflammation returned, and she was back to receiving monthly scalp injections at her dermatologist’s office.
The setback felt like starting over, she recalls. “Each time it gets better and then gets worse again, it's frustrating and disappointing,” Beaford says of managing the condition. “But I think that each time [regression] happens, I handle it a little bit better.”
She is now more focused than ever on channeling her energy into managing inflammation from the inside out by paying closer attention to her diet, cutting back on alcohol, and prioritizing stress reduction.
The strong connection between hair and identity in the Black community is well-documented, and Dr. Ogunleye and Dr. Lenzy both note that hair loss can lead to anxiety and depressive symptoms. Dr. Lenzy sits on the board of the Scarring Alopecia Foundation, which has virtual support group meetings so patients don’t feel alone in navigating permanent hair loss.
“The psychosocial impact of a CCCA diagnosis cannot be underestimated. It's a lot for patients to cope with,” says Dr. Lenzy. “We tend to find that patients who have more significant hair loss tend to have a greater emotional impact because it can get to the point where it's difficult to cover, difficult to camouflage with more and more progression.”
Although CCCA is most commonly diagnosed in patients in their 30s and 40s, Dr. Ogunleye and Dr. Lenzy have both treated individuals who presented with symptoms at a much younger age. The good news, they emphasize, is that research on the condition has advanced, leading to more treatment options than ever before. Where there used to be hopelessness, there is now more hope for individuals who experience hair loss.
“I think there are a lot of things that we normalize in our community when it comes to hair care, right?” says Dr. Ogunleye. “When you get braids and you can't sleep, and you're like, ‘Oh, pain is normal.’ Pain isn't normal. Tightness of the scalp isn't normal. Itching of the scalp isn't normal. Hair loss doesn't have to be normal.”
What should be normal is for patients to prioritize their health. Beaford says she remains committed to being vocal about her CCCA journey on YouTube and other social media platforms in an attempt to provide the support she wishes she had when she first noticed symptoms. Armed with a deeper understanding of her condition and the backing of both a trusted dermatologist and hairstylist, she is realizing that scarring alopecia feels less scary when she doesn’t have to face it alone.
Read more from The Melanin Edit's series on hair loss:
Follow Allure on Instagram, TikTok, and Substack, or subscribe to our newsletter to stay up to date on all things beauty.
