Scarring Alopecia in Women: Signs of FFA and CCCA

Reader note: This article is educational, not a diagnosis. Prescription decisions require a qualified medical professional; product claims and treatment suitability vary.

What "scarring" alopecia means

Alopecia is the medical word for hair loss. In most common types, such as female pattern hair loss or shedding after illness or childbirth, the hair follicle is still alive. It may be shrinking or resting, but it can still produce hair.

Scarring alopecia, also called cicatricial alopecia (sik-uh-TRISH-ul), is different. The AAD describes it as a condition that develops when inflammation destroys hair follicles. Once a follicle is destroyed, it cannot regrow hair. That is why the AAD stresses that catching scarring alopecia early can prevent further hair loss.

Scarring alopecias are not one disease. This guide focuses on two that often affect women: frontal fibrosing alopecia and central centrifugal cicatricial alopecia. Neither is contagious, according to the AAD.

The aim here is not to help you diagnose yourself. It is to help you recognize when "normal thinning" might not be normal, so you can get the right appointment sooner.

Frontal fibrosing alopecia: signs to notice

Frontal fibrosing alopecia (FFA) destroys hair follicles along the front and sides of the scalp, causing permanent hair loss in the affected area. According to the AAD, most people diagnosed are women, and it is usually diagnosed after menopause, although it can begin earlier. The AAD notes that earlier onset may be most common in Black women, while adding that more research is needed.

Common signs

• A receding hairline. Hair loss on the forehead and temples can look like a band of lighter skin along the front and sides of the hairline. It often develops slowly, which makes it easy to miss.
• Eyebrow loss. The AAD says many people with FFA notice eyebrow loss, and thinning at the outer edges of the brows can appear before the hairline recedes.
• Itch or pain. The AAD lists itch or pain as common early symptoms, which can come before visible loss.
• Small bumps. A rash of small bumps near the hairline may be red, skin-colored or yellow, and can feel scaly. Small raised bumps can also appear on the face.
• Loss elsewhere. As FFA advances, some people notice less hair in other places, such as the underarms, arms or legs.

The AAD also notes that FFA can sometimes come on rapidly or in patches rather than gradually. Without treatment, it often causes permanent loss that covers a larger area over time.

Central centrifugal cicatricial alopecia: signs to notice

Central centrifugal cicatricial alopecia (CCCA) is, according to the AAD, the most common cause of scarring hair loss in African American women in the US. It is more commonly seen in Black women and often begins in middle age, though it can also affect men and people of any race. The AAD notes that it runs in families.

Common signs

• Thinning at the crown. CCCA usually starts at the center or crown of the scalp as a small, round area of hair loss that grows outward over time.
• Burning, stinging or itching. Many people with untreated CCCA report these sensations on the scalp.
• Small bumps. Some people feel small, raised bumps on the scalp.
• Smooth skin. Once many follicles have scarred, the bald area can feel smooth to the touch.

Because it starts on top of the head, CCCA is easy to confuse with female pattern hair loss or with damage from styling. The AAD advises seeing a board-certified dermatologist for patchy hair loss at the center of the head, even if you are not sure you want treatment.

How these differ from more common hair loss

This table is a rough orientation, not a diagnostic tool. Conditions can look alike, and more than one can happen at the same time.

If tight styles are part of your routine, our guide to traction alopecia explains how tension damages the hairline. If you are around menopause and unsure whether you are seeing ordinary thinning, our comparison of perimenopause shedding and pattern loss may help, but keep FFA in mind if your hairline or eyebrows are changing.

Why timing matters

With most hair loss, waiting a few months to see what happens is a reasonable choice. With scarring alopecia, it can cost you hair you cannot get back.

• For FFA, the AAD says that, caught early, medical treatment can stop further hair loss, and that some people who are treated early may regrow some hair. Once a follicle scars, it can no longer grow hair.
• For CCCA, the AAD says early treatment aims to stop the condition from destroying more follicles. Some people regrow hair when treatment starts before follicles scar completely, while loss in fully scarred areas is more likely to be permanent.
• The AAD says over-the-counter products are not effective for CCCA, and that a dermatologist needs to prescribe medication.

This is why a serum, oil, supplement or a box of minoxidil should never be the first step if these signs sound familiar. Even a product that is useful for pattern hair loss can give a false sense that something is being done while the underlying inflammation continues.

How a dermatologist confirms it

A board-certified dermatologist is the specialist with the most experience diagnosing these conditions, according to the AAD. The AAD's Find a Dermatologist directory can help you locate one.

The visit usually starts with your history and a close look at your scalp, hairline and eyebrows. The AAD notes that if a disease, deficiency, hormone imbalance or infection is suspected, you may need a blood test or a scalp biopsy, in which a small sample of skin is removed for examination. These tests can be done in a dermatologist's office.

The AAD's CCCA page also notes that hair loss can sometimes signal another medical problem, such as a thyroid condition, and that low iron or certain vitamin deficiencies can also contribute. That is one more reason to let a clinician look at the whole picture.

Treatment is chosen by the dermatologist based on the diagnosis. For FFA, for example, the AAD notes that treatment may include prescription medicines such as an antibiotic and an antimalarial medicine. This guide does not suggest any specific treatment or dose; the right plan depends on your exam and history.

What to do before your appointment

Waiting for a dermatology appointment can feel long. These steps help you arrive prepared without adding anything that could cloud the picture.

1. Photograph the areas. Take clear pictures of your hairline, temples, eyebrows and crown in good light, and repeat them in the same way every few weeks.
2. Write down symptoms. Note any itch, burning, pain or bumps, and when they started relative to the hair loss.
3. List your styling history. Include tight styles, extensions, relaxers or chemical treatments, and how often you use them.
4. List everything you use. Bring a list of medicines, supplements and scalp or skin products.
5. Hold off on new hair-loss products until you have a diagnosis, unless a clinician has advised otherwise.

Our checklist for your first dermatology visit for hair loss has more questions to bring.

Questions readers ask

What is the difference between scarring and non-scarring hair loss?

In scarring alopecia, inflammation destroys hair follicles, and a destroyed follicle cannot regrow hair. In common non-scarring types, such as female pattern hair loss or shedding after illness, the follicle survives and can still produce hair.

What are the first signs of frontal fibrosing alopecia?

The AAD lists itch or pain as common early symptoms, sometimes before visible loss. Thinning at the outer edges of the eyebrows can appear before the hairline begins to recede in a band along the front and sides.

What does CCCA look like at the start?

CCCA usually begins as a small, round area of thinning at the center or crown of the scalp that grows outward over time. Many people notice burning, stinging or itching, and some feel small bumps on the scalp.

Can hair grow back with scarring alopecia?

Hair cannot regrow from follicles that have fully scarred. The AAD says that when FFA or CCCA is treated early, further loss can often be stopped and some people regrow some hair, which is why early diagnosis matters.

Can minoxidil or hair serums treat scarring alopecia?

They should not replace a diagnosis. The AAD says over-the-counter products are not effective for CCCA and that a dermatologist needs to prescribe treatment. Using a product first can delay care while inflammation continues.

How is scarring alopecia diagnosed?

A dermatologist examines the scalp, hairline and eyebrows and reviews your history. The AAD notes that a blood test or scalp biopsy may be needed, and both can be done in a dermatologist's office.

Sources and further reading

Related guidance

Medical note: This guide is general information, not medical advice. Hair loss has many causes; a licensed clinician who can examine your scalp and review your history should guide diagnosis and treatment.

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