Central centrifugal cicatricial alopecia (CCCA) is a type of hair loss that spreads from the middle of the scalp outward. The condition was believed to result from application of petrolatum followed by a stove-heated iron comb.

The original theory was that the hot petrolatum would travel down to the hair root, burn the follicle and after repetitive injury, scarring would result. The problem is more common among African American women, although the main causes are still not known very well.

The study conducted by the Cleveland Clinic involved 326 African American women who filled questionnaires about their hair-grooming methods, health status, and other demographic information. The researchers then performed a scalp examination to grade participants’ hair loss.

The findings published in the Archives of Dermatology showed that about all of the studied women straightened their curls chemically and about one in six had scarring hair loss.

About 60 percent of the women with a history of having braids, extensions or weaves showed signs of advanced central hair loss with scarring. The participants were also more likely to have bacterial scalp infections, and sport hairstyles associated with traction, including braids and weaves.

More than half the women with this condition said they had braids, weaves or hair extensions, as compared to only a third of those with less severe hair loss.

However, those women with little or no sign of hair loss were less likely to have used hot combs to straighten their hair than those with significant hair loss (42 percent, compared with 49 percent) and more likely to have had braids, extensions or weaves (48 percent, compared with 57 percent).

Those women with CCCA were also at a higher risk of developing type 2 diabetes. The fact puts weight behind a theory suggesting that CCCA may also be influenced by metabolic problems.

“Any style that causes too much tension and traction on the hair, such as braiding with artificial hair weaved in, can possibly lead to scarring hair loss,” said lead study author Dr Angela Kyei.

“It is harder to manage tightly curled hair and is often not socially acceptable to wear hair in its natural form for these women,” Kyei says. So some women turn to braids and weaves, and because these hairstyles can be costly, they are sometimes worn for extended periods.

“You can’t bring the hair back, so you should see a dermatologist who specializes in hair loss and let them evaluate your scalp,” she suggested to women with hair loss.

“But hair loss is permanent, meaning that we can inject steroids or creams but it won’t bring your hair back, so it’s very important to seek help with dermatologists early on,” she added.