Central centrifugal cicatricial alopecia (CCCA) is a type of scarring hair loss that primarily affects women of African descent. This condition leads to permanent hair loss because of inflammation and scarring on the scalp. Traditional treatments focus on controlling inflammation, but they don’t stop the scarring that causes hair follicles to be destroyed.
In this study, researchers explored the potential benefits of using a low dose of oral metformin, a drug usually used to treat diabetes, as an additional therapy for CCCA. Metformin has been known to have antifibrotic properties, which means it can help reduce scarring. The study involved 12 women of African descent who had CCCA that did not respond to standard treatments. They added low dose oral metformin to their existing treatment regimens and monitored the results over at least six months.
After this treatment, most participants (9 out of 12) reported improvements in symptoms like scalp pain, itching, and inflammation. Six patients even showed signs of hair regrowth. To understand why metformin might help, the researchers took scalp biopsies from some of the patients and studied the changes in gene activity before and after metformin treatment.
The gene analysis showed that metformin activated pathways involved in hair growth (including keratin-associated proteins, epidermis, and hair cycle pathways) while simultaneously reducing the activity of genes related to scarring and fibrosis (like helper T cell 17 and epithelial-mesenchymal transition pathways). This suggests that metformin can potentially mitigate the scarring process that typically leads to permanent hair loss in CCCA.
Overall, the study offers promising evidence that low-dose metformin may not only improve symptoms but also promote hair regrowth by targeting both inflammation and scarring in CCCA. The researchers recommend further studies to confirm these findings and to explore the use of metformin in other scarring hair loss conditions.
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Article summary by Soneet Dhillon, MS Chicago Medical School MD, MSHA Candidate | Reviewed by Farah Moustafa, MD
Reference:
Bao A, Qadri A, Gadre A, Will E, Collins D, Ahima R, Bordone LA, Aguh C. Low-Dose Metformin and Profibrotic Signature in Central Centrifugal Cicatricial Alopecia. JAMA Dermatol. 2024 Sep 4:e243062. doi: 10.1001/jamadermatol.2024.3062. Epub ahead of print. PMID: 39230880; PMCID: PMC11375521.
