Researchers at Mayo Clinic in Jacksonville reviewed 23 years of patient records, from 2000 to 2022, to compare one kind of hair loss against the others in its family. The condition is central centrifugal cicatricial alopecia, usually shortened to CCCA. Cicatricial means scarring, and a scarring alopecia is one where the follicle itself is destroyed and replaced with scar tissue, so hair in that area does not come back. CCCA typically begins at the crown and spreads outward, and it is most often diagnosed in Black women. The team identified 54 patients with CCCA and 270 patients with other scarring alopecias to serve as the comparison group. Every diagnosis in the study was confirmed by biopsy. They reported that patients with CCCA were less likely to improve after treatment than the comparison group, 31.5% versus 59.6%. The two groups had also been treated differently. CCCA patients were more often prescribed oral antibiotics, 55.6% versus 33.0%, and less often prescribed oral 5-alpha-reductase inhibitors, 1.9% versus 16.3%, or hydroxychloroquine, 13.0% versus 37.8%. Those last two are prescription pills. The first group blocks a hormone conversion inside the follicle, and hydroxychloroquine is an anti-inflammatory used in autoimmune conditions.

Two other comparisons stand out. A family history of unspecified hair loss was reported more often by CCCA patients, 38.9% versus 14.8%. So were the styling practices the authors tracked: high-tension hairstyles, which they defined as braids, cornrows, extensions and tight ponytails, at 46.3% versus 2.2%; heating tools, defined as curling irons, flat irons and hot combs, at 14.8% versus 3.0%; and chemical relaxers, perms or dyes, at 44.4% versus 6.7%. The authors did not present those numbers as evidence that styling caused the condition. They wrote that the higher rates may instead reflect the fact that CCCA is more common in Black patients, who are more likely to use those techniques in the first place. They also raised genetics as one possible reason CCCA responded less well to treatment, and they listed their own limitations plainly: the study was retrospective, meaning it looked back through existing charts instead of following patients forward in time; the data came from a single tertiary referral center, which tends to see more complex cases than a general practice; and long-term follow-up was limited. The study reported no funding and no conflicts of interest.

Here's the study: Wang KL, Pincelli TP, Wentworth AB, White LJ, Li Z, Sokumbi O, Bruce AJ. Central centrifugal cicatricial alopecia: retrospective case-control study of 54 patients from a tertiary care center. International Journal of Women's Dermatology, 2025;11(2):e206. doi:10.1097/JW9.0000000000000206. Read the full text here.

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