Low-dose metformin associated with central centrifugal cicatricial alopecia improvement
Click Here to Manage Email Alerts
Key takeaways:
- Most patients experienced improvement in CCCA symptoms, and six had hair regrowth.
- Gene pathways identified in CCCA were shown to be upregulated or downregulated after metformin treatment.
Down regulation of fibrotic processes and upregulation of keratinocyte proliferation was associated with low-dose metformin in patients with central centrifugal cicatricial alopecia, or CCCA, according to a study.
“Evidence has shown that many patients with CCCA will have evidence of insulin resistance, which can be identified through a hemoglobin A1c score greater than 5.6 or as evidenced by a Homa IR score greater than 2. For these patients, metformin may be a helpful off-label therapy,” Crystal Aguh, MD, associate professor in the department of dermatology and director of the Ethnic Skin Program at The Johns Hopkins University School of Medicine, told Healio.
Metformin, an antidiabetic drug, upregulates adenosine monophosphate kinase (AMPK), which enhances insulin sensitivity, Aguh and colleagues wrote.
The researchers conducted a retrospective case series of 12 Black female patients with CCCA, confirmed by biopsy, who had not responded to conventional therapies. Each patient received oral, extended release 500 mg metformin once daily, in addition to their previous treatment regimen.
Eight patients experienced improvement in scalp pain, inflammation and/or pruritus after 6 months of treatment, with worsening of clinical symptoms reported in two patients.
Clinical hair growth was shown in six patients, with hair loss regression occurring in one patient after discontinuing metformin.
Scalp biopsies from before treatment and at least 6 weeks after treatment were available from four patients, which were used for differential gene expression analysis.
Out of 16,655 genes, 34 were identified to have been upregulated and eight had been downregulated after metformin treatment.
Those that were upregulated included pathways related to keratinization, epidermis development and hair cycle, whereas those associated with extracellular matrix organization, collagen fibril organization and collagen metabolism were among those downregulated.
“In this study, we noted clinical response in a majority of patients seeing regrowth, which correlated in a downregulation of fibrotic pathways characteristic of CCCA. As there are currently no FDA approved treatments for CCCA, the results of this study help to add an additional treatment option for patient suffering from this disease,” Aguh said. “Additionally, it helps us understand a little bit more about the disease pathogenesis and can potentially help us identify new options for CCCA as well as other forms of alopecia.”
For more information:
Crystal Aguh, MD, can be reached at cagi1@jhmi.edu.
Collapse
Read more about
Click Here to Manage Email Alerts