Adjuvant Use of Topical Metformin With Standard Therapies in Recalcitrant Central Centrifugal Cicatricial Alopecia: A Case Series

This case series explores the use of topical metformin as an adjuvant treatment for central centrifugal cicatricial alopecia (CCCA) in 3 Black female patients who had limited success with standard therapies. The addition of topical metformin to existing treatments, such as minoxidil and steroids, resulted in significant improvement in hair density and regrowth over 6 to 10 months. The study suggests that metformin's potential mechanisms, including anti-fibrotic effects and reduction of circulating androgens, may contribute to its efficacy. The authors recommend considering topical metformin as part of initial therapy for CCCA, although larger clinical trials are needed to confirm these findings.