Hair loss does not look or behave the same way in every patient, and hair characteristics can influence both the pattern of hair loss and the practical considerations when treatment is planned. Women with Afro textured hair can be affected by conditions such as traction alopecia and central centrifugal cicatricial alopecia, which require particular attention because some forms of hair loss can become permanent when follicles are damaged or destroyed. Getting the diagnosis right is therefore an important first step.
Traction alopecia
Traction alopecia is hair loss caused by prolonged or repeated tension on the hair and scalp. It can occur with tight braids, weaves, extensions, ponytails and other styles that place sustained tension on the follicles. It commonly affects the front and sides of the scalp. Early traction alopecia may improve when the source of tension is removed, while longstanding disease can lead to permanent follicular damage and scarring.
Central centrifugal cicatricial alopecia (CCCA)
CCCA is a common form of scarring hair loss that disproportionately affects women of African descent. It often begins in the central scalp or crown and can gradually extend outward. Some patients experience itching, burning, tenderness or small bumps, while others have few symptoms. The cause is not completely understood, but inflammation and genetic factors appear to be involved. It is important not to assume that CCCA is simply caused by hairstyling, as the relationship between grooming practices and CCCA remains incompletely understood.
The important point for anyone noticing progressive thinning at the crown, scalp symptoms or a spreading area of hair loss is that CCCA should be assessed early. Once a follicle has been destroyed and replaced by scar tissue, that follicle cannot produce hair again. Early medical treatment may help control inflammation and reduce further progression, although the response varies between patients.
“When I see a woman with a spreading area of thinning at the crown, or symptoms such as itching, burning or scalp bumps, I want to establish the diagnosis before we talk about restoration. With scarring alopecia, the priority is to identify whether there is active disease and control it early. A transplant cannot replace the need to treat an underlying inflammatory condition.”
— Dr Kashmal Kalan
Other causes worth ruling out
Women with Afro textured hair can also develop the same nonscarring conditions seen in other patients, including androgenetic (pattern) hair loss, alopecia areata (an autoimmune condition causing patchy loss) and telogen effluvium (temporary, diffuse shedding often linked to stress, illness or hormonal change). They may also have more than one condition at the same time. Distinguishing between these diagnoses and conditions such as traction alopecia or CCCA requires a proper scalp examination and, when appropriate, trichoscopy (a magnified scalp-examination technique) or further investigation.
Treatment approaches
Treatment depends on the diagnosis and the stage of the condition. Early traction alopecia is generally managed by reducing or eliminating the source of tension, with additional medical treatment considered when there is inflammation. CCCA requires appropriate medical management aimed at controlling disease activity. Hair transplantation may be considered in selected patients with scarring alopecia when the disease has been inactive and stable for an appropriate period, the recipient area is suitable, and expectations are realistic. Afro textured hair also presents specific technical considerations because the follicle can curve beneath the skin, which can affect how extraction and implantation are planned and performed.
“Before I recommend transplantation in someone who has had traction alopecia or CCCA, I am looking at more than the area that has lost hair. I want to understand the diagnosis, whether the condition is genuinely stable, the quality and distribution of the donor hair, the condition of the scalp and the patient’s long term expectations. With Afro textured hair, the shape of the follicle beneath the skin also matters because it changes the technical approach to harvesting. The aim is to make sure that surgery is appropriate before we proceed.”
— Dr Kashmal Kalan
Frequently asked questions
Is traction alopecia reversible?
Often, if it is identified early and the source of tension is removed, hair density can improve. If follicular damage has progressed to scarring, however, the affected follicles may be permanently lost.
Can CCCA be cured?
There is currently no established cure for CCCA. Medical treatment can help control inflammation and may slow or stop further progression. Some regrowth may occur when follicles remain viable, but hair loss from follicles that have been permanently destroyed is generally irreversible.
Can I get a hair transplant after CCCA or traction alopecia?
In selected patients, transplantation may be considered once the underlying condition has been inactive and stable and the scalp and donor area are suitable. This decision requires individual assessment, and patients should understand that transplantation in a previously scarred area can have less predictable results than transplantation into unaffected scalp.
If you are noticing thinning, a spreading patch or symptoms such as itching, burning or scalp tenderness, it is worth having the cause assessed rather than assuming that it is pattern hair loss. Establishing the diagnosis early is particularly important when scarring alopecia is a possibility. Our HPCSA-registered doctors can provide that assessment — speak to one of our doctors for an individual, unhurried evaluation of what’s actually causing it.
Sources consulted:
- Central centrifugal cicatricial alopecia overview (American Academy of Dermatology)
- Central Centrifugal Cicatricial Alopecia (StatPearls, NCBI)
- Dermoscopy of Traction Alopecia in Black Scalp Patients: Insights from a Literature Review (PubMed)
- Comparative Study of a Novel Tool for Follicular Unit Extraction for Individuals with Afro-textured Hair (PubMed)