To decrease inflammation, you might receive topical anti-inflammatories, like cortisones. Dr. Henry says intralesional steroid injections can also help. “They can provide deeper anti-inflammatory penetration and are a standard treatment for active traction alopecia.”
Both doctors suggest a low dose of minoxidil, depending on the severity of the case. Minoxidil “helps those residual hairs to thicken,” Dr. Lenzy says. “Because a lot of times, the hairs that are left are very, very thin and fragile.” Dr. Henry adds that this is an option for someone who might have difficulty keeping up with topical formulations.
Dr. Henry also offers platelet-rich plasma (PRP). “While evidence is limited to case reports and small series for scarring/traction alopecias, PRP has shown promise in slowing disease progression and reducing inflammation,” she says.
Central centrifugal cicatricial alopecia
Hair loss at the crown of the head that spreads outward is known as central centrifugal cicatricial alopecia, or CCCA. The exact cause of CCCA is unknown. While certain hair-care practices and hairstyles (like high puffs and tight ponytails) have been said to trigger scarring in the crown area that leads to hair loss, there seems to be more to the cause of the condition than just how to style your hair.
A lot more research is being conducted to try and pinpoint why CCCA happens, says Dr. Lester. “There are people who’ve always used low-tension hairstyles and have never used chemicals or anything like that who also get it,” she says. “So it’s not just about hairstyling.”
Cicatricial comes from the Latin word for scar, and CCCA is the most common form of scarring hair loss in Black women, as noted by multiple dermatologists on our expert panel. Inflammatory cells, such as lymphocytes, lead to the destruction of the hair follicle, explains Dr. Lenzy.
How to treat it: Proper diagnosis precedes treatment. In her practice, Dr. Lenzy performs a biopsy to properly diagnose the condition—which can often be mistaken for other forms of alopecia. Using a microscope, a pathologist can see the inflammatory cells. In a case of CCCA, “the hair follicle becomes replaced with scar tissue,” she says. “So if we look at it under the [dermatoscope] we no longer see the hair follicles. We see scar tissue.”
Areas that are scarred in this way generally do not grow back, Dr. Lenzy adds. Some people, however, will have hairs that have “stunted growth,” she notes, which dermatologists can encourage to grow back by controlling the inflammation and adding in other treatment options.
This is why the early and accurate diagnosis of CCCA is so important, says Dr. Lenzy, adding that she also tends to treat CCCA more aggressively than other forms of hair loss. “I have found that when it’s not treated aggressively enough, it tends to progress faster,” she says. “So I use things like oral antibiotics, not because it’s an infection, but because the antibiotics are anti-inflammatory.”
Dr. Lenzy also uses some of the same treatments for traction alopecia to treat CCCA—like topical corticosteroids compounded with minoxidil. And she sometimes opts for steroid injections for deeper penetration into the scalp and nutraceuticals to help with the growth and thickness of the residual hairs.