WEDNESDAY, Sept. 4, 2024 -- For patients with central centrifugal cicatricial alopecia (CCCA), which predominantly affects Black women, low-dose metformin is associated with symptomatic improvement and modulation of gene expression, according to a study published online Sept. 4 in JAMA Dermatology.

Aaron Bao, from the Johns Hopkins University School of Medicine in Baltimore, and colleagues examined the association of low-dose oral metformin (500 mg extended-release, once daily) with clinical symptoms and scalp gene expression patterns in patients with CCCA in a retrospective clinical case series and transcriptomic analysis. The study included 12 Black female patients; transcriptomic analysis was performed in four patients.

The researchers found that nine of the participants experienced improvement in disease, including scalp pain, inflammation, and/or pruritus after at least six months of metformin treatment, and six demonstrated clinical evidence of hair regrowth. Reversal of many prominent gene pathways previously identified in CCCA was reversed by the addition of metformin. Upregulation of pathways and genes involved in keratinization, epidermis development, and the hair cycle was seen in transcriptomic analysis, with concomitant downregulation of fibrosis-related pathways and genes. Reduced expression of helper T-cell 17 and epithelial-mesenchymal transition pathways and elevated adenosine monophosphate kinase signaling and keratin-associated proteins were seen after metformin treatment in a gene-set analysis.

"Adjuvant low-dose oral metformin was associated with symptomatic improvement, clinical evidence of hair regrowth, and modulation of gene expression profiles," the authors write.

One author disclosed ties to the pharmaceutical industry and has a related patent pending.