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multifactorial. Small white nodules are often seen throughout the hair, which correspond to
loss of the hair cuticle. This condition can take two to four years to completely resolve, but
optimising hair care and stopping damaging practices are crucial to hair regrowth
Central centrifugal cicatricial alopecia (CCCA)
Central centrifugal cicatricial alopecia is a form of scarring (permanent) hair loss and is the
most common cause of hair loss in women of African descent. The hair loss starts in the
centre of the scalp and spreads outwards, hence its name. The disease is characterised
by inflammation around the hair follicles, which leads to follicle destruction and scarring.
CCCA was previously known as “hot comb alopecia”, as it was thought that hair care
practices were the most important factor in the disease process. Currently, the cause is
not completely understood, but it is most likely due to a combination of multiple factors,
including genetics and a predisposition to autoimmunity and fibrosis.
Cultural significance
Hair has an important position in the black community, particularly amongst women.
The significance of hair within black history is well documented; indeed, hairstyles were
historically used to indicate a person’s tribe and even their place in society in many African
cultures. The slave trade carried millions of Africans across the Atlantic and Afro-textured
hair was frowned upon by slave masters and society as a whole, causing many slaves to
develop a negative relationship with their hair. Following emancipation, straighter hair
became more fashionable, as many African Americans sought to adhere to European
beauty standards. Furthermore, straighter hair was marketed as more manageable and
versatile and many African Americans began using chemical relaxers and heat tools.
Indeed, America’s first black female millionaire, Madam CJ Walker made her fortune
selling such products post-emancipation.
The Afro became popular during the 1960s civil rights movement, often serving as a
political statement. The 2000s ushered a new natural hair movement, with many black
women choosing to wear their hair in its natural state, many after years of relaxing their
hair. The term “big chop” is used to describe cutting off a woman’s relaxed hair so that she
can grow new, naturally curly and kinky hair again. Natural hair influencers on social
media, YouTube and personal blogs have undoubtedly played an important role in this
movement, empowering many women to familiarise themselves with their natural hair,
should they choose to do so.
Today, there are numerous hairstyles that are popular amongst people of African descent.
For some, hairstyles are chosen based on ease of maintenance, while for others,
hairstyles can be chosen to reflect a religious or social position, such as dreadlocks
amongst the Rastafarian community. It’s important to remember that many women will
cycle through several different hairstyles as per their personal preference and no hairstyle
is superior to another, although certain habits and methods of styling increase the risk of
hair damage and loss.