Hair Regrowth in Two Patients with Recalcitrant Central Centrifugal Cicatricial Alopecia After Use of Topical Metformin

In the 2020 case report, two patients with recalcitrant central centrifugal cicatricial alopecia (CCCA), a progressive scarring alopecia predominantly affecting women of African descent, experienced hair regrowth after using topical metformin. The first patient, a 69-year-old woman with stage 4a CCCA, saw substantial regrowth after 6 months of daily application of 10% metformin cream, following minimal improvement with standard therapies. The second patient, a 54-year-old woman also with stage 4a CCCA, noted improvement after 4 months of daily use of the same treatment. CCCA is characterized by fibrosis rather than inflammation, similar to other fibroproliferative disorders (FPDs). Metformin, an AMPK activator, has shown efficacy in improving fibrosis in FPDs and was chosen for topical use to minimize systemic absorption. No systemic adverse effects were reported, though patients experienced scalp dryness and irritation, which improved with moisturizers. The study suggests that topical metformin may be beneficial for CCCA patients unresponsive to standard treatments, but larger randomized controlled studies are needed to fully understand its potential.