Article Summary by Soneet Dhillon, MS | MD Candidate | Chicago Medical School

Central centrifugal cicatricial alopecia (CCCA) is a poorly understood type of scarring hair loss that occurs primarily in African American women, often without overt signs of inflammation (1). However, the persistent irritation and mild inflammation leads to end stage fibrosis (the thickening and scarring of skin/hair follicles), which permanent scarring (2). This disease process is like ‘fibroproliferative disorders (FPD)’, which also include uterine fibroids. Previous studies show that women with CCCA have a 5-fold increased risk of developing uterine fibroids (3).

Metformin (commonly used for type 2 diabetes) has shown to improve fibrosis in mouse models. Given that the disease pathway overlaps with fibrotic diseases, researchers wanted to see if metformin, which is commonly used for type 2 diabetes, could be used for patients with CCCA. They report a successful treatment result in two patients with CCCA to improve hair regrowth. (4)

The first patient was a 69-year-old black woman who experienced progressive hair loss that started in her late 50s. She tried topical and intralesional steroids, minoxidil foam and supplements with no success (4). After 5 years without success on standard treatment the patient elected to stop intralesional steroids and minoxidil. She then tried the 10% metformin cream, which caused significant hair regrowth. She started metformin 10%, 3 times per week and then moved to daily application.

The second patient was a 54-year-old black woman who noticed hair loss in her early 40s (4). She was treated with intralesional and topical steroids, minoxidil, and ketoconazole for 9 months with marginal improvement. She decided to continue taking minoxidil and intralesional steroids and added 10% metformin cream once daily. She experienced notable hair regrowth in 4 months.

Patients reported dryness and scalp irritation with metformin use that improved with topical moisturizer (4). This preliminary study shows that there is potential to use metformin for hair regrowth in patients with CCCA.

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References:

1. Olsen EA, Callender V, Sperling L, McMichael A, Anstrom KJ, Bergfeld W, et al. Central scalp alopecia photographic scale in African American women. Dermatol Ther 2008;21(4):264-7 doi 10.1111/j.1529-8019.2008.00208.x.
2. Gabros S, Masood S. Central centrifugal cicatricial alopecia. StatPearls [Internet]: StatPearls Publishing; 2022.
3. Dina Y, Okoye GA, Aguh C. Association of Uterine Leiomyomas With Central Centrifugal Cicatricial Alopecia. JAMA Dermatol 2018;154(2):213-4 doi 10.1001/jamadermatol.2017.5163.
4. Araoye EF, Thomas JAL, Aguh CU. Hair regrowth in 2 patients with recalcitrant central centrifugal cicatricial alopecia after use of topical metformin. JAAD Case Rep 2020;6(2):106-8 doi 10.1016/j.jdcr.2019.12.008.