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

Topical pirfenidone is highlighted as an effective anti-inflammatory and anti-fibrotic treatment for hair loss, particularly in addressing perifollicular fibrosis, which may enhance the effectiveness of standard treatments like finasteride and minoxidil. The user also uses calcipotriol, MCT oil, ciclopirox shampoo, and benzoyl peroxide shampoo as part of their regimen.

Topical tacrolimus is being considered for androgenetic alopecia, though its effectiveness is unproven. Other treatments mentioned include minoxidil, dutasteride, cyclosporine, and teicoplanin, with discussions on blocking the prolactin receptor for hair growth.

The conversation discusses using a TCA 35% chemical peel on the scalp to potentially improve hair growth by addressing fibrosis and enhancing the effectiveness of topical treatments. The user also mentions trying microneedling and other methods like topical metformin and dutasteride for hair regrowth.

The user is experiencing diffuse thinning and inflammation despite using 2.5mg dutasteride daily, ciclopirox, and ketoconazole shampoos. They are considering treatments like hydroxychloroquine and JAK inhibitors due to suspected scarring alopecia and have faced challenges in obtaining a scalp biopsy.

Topical caffeine is suggested as a beneficial adjunct treatment for hair growth due to its anti-fibrotic, anti-inflammatory, antioxidant, and other properties. There is skepticism about its effectiveness, especially at low concentrations like in Alpecin liquid.

The user is considering using CB or clascoterone for hair loss, potentially as an alternative to RU. They're also contemplating asking a dermatologist for topical clascoterone cream to apply to their temple.