Do Relaxers Cause Crown Hair Loss (CCCA)?What Studies Show

Central centrifugal cicatricial alopecia (CCCA) is a scarring hair loss that starts at the crown and spreads outward. It’s the most common scarring hair loss in women of African descent and usually begins in middle age.¹ Because scarring destroys follicles, early diagnosis matters.

The old suspect: hot combs and relaxers

The condition was once called “hot comb alopecia.” In 1992, a study of 10 Black women with it found poor correlation between hot comb use and when the hair loss began or progressed.² The authors said the women’s histories were incompatible with the idea that hot combs cause it.²

Later studies kept checking:

Study	Relaxers or hot combs	What did show a link
Detroit, 51 women with CCCA vs 50 without	No link3	Sewn-in weaves, and braids or cornrows with extensions3
US workshops, 529 African American women	No obvious link4	A past fungal scalp infection4

The Detroit study relied on women remembering past styles,³ and the workshop study didn’t confirm diagnoses with biopsies.⁴

Dermatologists now say hairstyles may play a role but that this hasn’t been proven. Some women with CCCA have never used relaxers, and most women who use relaxers never get it.¹

A gene enters the picture

A 2019 international study found changes in a gene called PADI3, which helps build the hair shaft, in 5 of 16 women with crown hair loss and 9 of 42 in a second group with CCCA.⁵ The changes were more common than in women of African ancestry without CCCA.⁵

Most women with CCCA didn’t carry the variants, so the gene is one piece of the picture, not a test you can order. It fits with dermatologists’ observation that CCCA runs in families.¹ Women with CCCA are also more likely to have type 2 diabetes.¹

What this means for you

1. Don’t wait out crown thinning. Itching, tenderness or a shiny, smooth patch can be signs of scarring.¹ See CCCA treatment goals.
2. Ease tension. The Detroit study’s links were with pulling styles; see traction alopecia signs.
3. Mention family history and conditions like diabetes at the appointment.¹
4. Drop the guilt. The studies don’t show that relaxers or hot combs cause CCCA.

For relaxers and other health questions, see hair relaxers and uterine cancer.

Try: “The crown of my head has been thinning for a year, and it itches. My mother had the same thing. Could this be CCCA, and could we do a biopsy?”

Hair, Everywhere covers this in Chapter 9, “Edges,” in a section called “The Crown.” Its Hair Log keeps monthly photos of your crown in the same light, so a dermatologist can see whether the patch is spreading. See the book.