Hair loss in Black women: traction alopecia, CCCA, and what to do early

Hair loss in Black women is not one condition. The two most important to recognize early are traction alopecia and central centrifugal cicatricial alopecia (CCCA), because both can cross from reversible to permanent. Traction alopecia comes from mechanical pulling on the follicle. CCCA is an inflammatory scarring disease that disproportionately affects Black women.

Beyond those two, diffuse thinning across the whole scalp often points elsewhere: telogen effluvium triggered by stress, illness, or childbirth; an underactive thyroid; or iron deficiency. These causes are usually reversible once the underlying problem is treated. Naming the cause correctly is the whole game, because the scarring types have a closing window and the others do not. If you want a doctor who takes Black hair and scalp seriously, our provider directory lists clinicians by specialty and location.

Traction alopecia is caused by repeated tension on the hair follicle. The AAD names the usual culprits directly: cornrows, locs, tightly braided hair, tight buns, ponytails and up-dos, and hair extensions or weaves, especially on relaxed hair. It is most common in women of African descent, and one review estimates that roughly a third of women of African descent who wear traumatic hairstyles for a prolonged period develop it.

The condition is biphasic. In the early stage it is non-scarring and reversible: change the styling and the hair recovers. If the pulling continues, the follicle scars and the loss becomes permanent. As the AAD puts it, "When traction alopecia advances to this stage, your hair cannot grow back."

A simple rule keeps you on the reversible side. The AAD advises: "If your hairstyle feels painful, the style is too tight." Their protective-styling guidance is concrete: loosen braids especially around the hairline, opt for thicker braids and locs, wear braids no longer than 6 to 8 weeks, switch up your hairstyle regularly so the scalp can recover, wear weaves for short periods, and remove any style immediately if it causes pain. The Skin of Color Society frames it the same way: "The best treatment of traction alopecia is prevention."

Central centrifugal cicatricial alopecia is the most common form of scarring alopecia in Black women, with prevalence estimates roughly in the 3 to 6 percent range, and experts believe it is underdiagnosed. It most often affects Black women between about 30 and 55, and an early sign is often unexplained hair breakage before visible thinning.

CCCA is a scarring alopecia, and that word is the reason it is urgent. The AAD explains the mechanism plainly: "Once a hair follicle has been destroyed, it is replaced by scar tissue. This is why hair loss can be permanent." The loss "often begins in the center of the scalp as a small, balding, and round patch that grows over time," spreading outward from the crown. Many people with untreated CCCA report that the scalp burns, stings, or itches, and some develop small raised bumps.

Here is the part that changes outcomes. According to the AAD, "Starting treatment early can prevent CCCA from spreading outward and causing more permanent hair loss. Some people also have hair regrowth when treatment starts early." Wait, and the window closes: where scar tissue has already replaced follicles, no treatment can bring hair back. This is why a widening patch at the crown is a reason to book a dermatologist now, not after the next style grows out. Our CCCA atlas page shows what it looks like on Black skin at different stages.

Telogen effluvium is a non-scarring, diffuse shedding that shows up about 2 to 3 months after a triggering event. Common triggers include the postpartum period, high fevers and severe illness, major surgery or trauma, emotional stress, crash dieting and nutritional deficiency, thyroid disorders, and certain medications. Unlike the scarring types, it does not destroy follicles. It is self-limiting and usually resolves over roughly six months once the trigger is addressed, though full cosmetic regrowth can take 12 to 18 months. The most important step is identifying and correcting the trigger.

Two reversible causes hide in routine labs. An underactive thyroid can drive chronic telogen effluvium, and a thyrotropin (TSH) test is warranted when hypothyroid symptoms such as fatigue, constipation, weight gain, and cold sensitivity are present. Iron deficiency is the other. Iron deficiency without anemia shows up in a meaningful share of telogen effluvium cases and may register only as a low serum ferritin; low ferritin confirms iron deficiency, though a normal ferritin does not rule it out because inflammation can falsely raise it.

These overlap with the broader picture of hair, skin, and nail changes that send Black women to the doctor. For the thyroid side, see our guide to thyroid skin and hair signs in Black women. For iron, see iron-deficiency anemia in Black women.

Treatment depends entirely on which cause is at work, which is why diagnosis comes first.

For traction alopecia, the front-line treatment is removing the tension: change the style early and the hair recovers. Once scarring sets in, that window has closed for the affected follicles.

For CCCA, a dermatologist makes the diagnosis, sometimes with a scalp biopsy, numbing the scalp and removing a small bit of skin to examine under a microscope. Treatment aims to stop or slow the loss, relieve symptoms, and regrow hair where possible. Corticosteroids reduce inflammation, applied topically or given as monthly injections over six to eight months, and dermatologists may add an antibiotic such as doxycycline or minocycline for its anti-inflammatory effect. The AAD is explicit that home minoxidil alone cannot prevent further CCCA loss, because anti-inflammatory prescription medication is the core of treatment.

For telogen effluvium, thyroid disease, and iron deficiency, the treatment is fixing the underlying cause. There is no specific drug for telogen effluvium itself; correcting the trigger and waiting out the natural course is the management.

Book a dermatologist if you notice any of these:

• Thinning at the hairline or temples, or a feeling of tightness or pain from a style.
• A small bald patch or widening thin area at the crown of the scalp.
• Scalp burning, stinging, itching, or small raised bumps.
• Unexplained hair breakage before visible loss.
• Diffuse shedding that does not slow after a few months, or shedding with fatigue, weight change, or other thyroid or anemia symptoms.

The principle is the same across the scarring types: scarring is permanent, and early care is what preserves follicles. You can find a clinician through our provider directory.