Central Centrifugal Scarring Alopecia (CCSA): An Overview of What It Is and What to Do

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This terminology refers to a hair loss condition that is a frequent cause of permanent baldness.  Typically it is characterized by appearing as a pattern of progressive hair loss, with scarring at the crown of the scalp.

While all ethnic groups can develop this type of hair loss, there is a high prevalence in African American women.

The problem first appears as a localized area of hair loss, usually in the middle of the scalp at the area of the crown.  Some individuals who develop this problem remember experiencing some itching, or tenderness, irritation in the area, but in many cases the problem starts silently with no noticeable discomfort at all.

As time goes by, the area changes so that a person either personally becomes aware that the hair growth is thinner in the area, or at times it is first brought to their attention by a hair care professional.

And here is where the first key decision is made that can have a big impact on the future progression of the disease.

One group of individuals decide to give it some time and see if the hair will start to grow back, especially if there is no irritation present.  If not monitored closely, the thinning can progressively expand to involve a larger and larger area of the scalp until the day arrives when an individual suddenly becomes alarmed and realizes that something is really wrong with the scalp.   Many times the initial reflex is to start using a product that is sold for the purpose of growing hair and/or to find a way to cover the thin area with a wig or hair piece attached by glue or sewing it in or hair clips.

Either way, the condition can continue to become more and more noticeable as the area of thinning worsens by the month and by the year. This gradual, symmetric, centrifugal spreading alopecia occurs over many years.

At some point along this timeline, another group of individuals either at the very beginning or many years later make a decision to see a medical specialist such as a dermatologist.

When an initial examination is performed, the affected scalp is oftentimes shiny, and hard to the touch with variable sized areas of scalp tissue with no hair follicles present.  While the individual who is affected only notices thinning of the hair, there has actually been damage to the scalp that wiped out hair follicles leaving light or darkened areas of scar tissue behind.

This brings us to a point; the earlier diagnosis and treatment are done the better.  Making an accurate diagnosis can require physically examining the scalp as well as performing a skin biopsy from the area of hair loss.  The results can indicate when treatment is appropriate

Early diagnosis and treatment is critical to getting the condition under control, relieving the symptoms and preventing large areas or permanent baldness from developing.

Steroid medications delivered topically or by intralesional injection as well as oral antibiotic and other anti-inflammatory medications are used for treating this concern so that the destruction that is happening to the hair follicles is stopped..

Due to the slow nature of hair growth, this treatment process will usually need to be continued for a period of at least 6 to 12 months to get the scalp to heal and turn off the damaging inflammatory process.

When areas of hair loss remain after medical treatment is complete, hair transplant surgery can be an option if the disease process has stopped and the scalp is completely healed.

The cause of this condition is frequently unknown, but it can be aggravated tension on the hair caused by tight braids or traction, as well as chemical irritation or bonding glue.  There definitely seems to be a correlation between the growing incidence of more and more individuals developing this problem with the growth of popularity of extensions and weaved hair styles over the past several decades.

So, the moral of this story is this:  if hair thinning starts in the middle of the top of the scalp it is wise to seek medical evaluation as early as possible.  Also it would be wise to avoid those hair styling techniques that can aggravate or potentially cause the problem to develop in the first place.

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