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Bao A, Qadri A, Gadre A, Will E, Collins D, Ahima R, Bordone LA, Aguh C. Low-Dose Metformin and Profibrotic Signature in Central Centrifugal Cicatricial Alopecia. JAMA Dermatol 2024:2822779. [PMID: 39230880 PMCID: PMC11375521 DOI: 10.1001/jamadermatol.2024.3062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Importance Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia predominantly affecting Black female individuals. Current conventional treatments target inflammation but not the underlying fibrotic processes, often leading to permanent hair loss. Objective To investigate the associations of low-dose oral metformin, an antidiabetic medication with antifibrotic properties, with clinical symptoms and scalp gene expression patterns in patients with CCCA. Design, Setting, and Participants This retrospective clinical case series and transcriptomic analysis included patients treated at a single tertiary academic medical center between January 2023 and March 2024. All patients had biopsy-confirmed CCCA refractory to standard treatments. Transcriptomic analysis was performed on patients with previously banked, paired scalp biopsies before and after treatment with adjuvant metformin for at least 6 weeks. Exposure Extended-release metformin, 500 mg, once daily was added to participants' baseline CCCA treatment regimens. Main Outcomes and Measures Clinical assessments included pruritus, inflammation, scalp resistance, and hair regrowth. Gene expression profiling via bulk RNA sequencing analysis evaluated differential gene expression and pathway enrichment. Results A total of 12 Black female participants were included in the study, and transcriptomic analysis was performed in 4 participants. After at least 6 months of metformin treatment, 9 participants experienced improvement in disease, including scalp pain, inflammation, and/or pruritus, and 6 demonstrated clinical evidence of hair regrowth. The addition of metformin led to reversal of many prominent gene pathways previously identified in CCCA. Transcriptomic analysis revealed upregulation of pathways and genes (keratin-associated proteins [KRTAPs]) involved in keratinization, epidermis development, and the hair cycle (absolute log2-fold change > 4), with concomitant downregulation of fibrosis-related pathways and genes (eg, MMP7, COL6A1) (fold change >1.5; all false discovery rate <.05). Gene set analysis showed reduced expression of helper T cell 17 and epithelial-mesenchymal transition pathways and elevated adenosine monophosphate kinase signaling and KRTAPs after metformin treatment. Conclusions and Relevance In this case series of patients with treatment-refractory CCCA, low-dose oral metformin was associated with symptomatic improvement and dual modulation of gene expression, stimulating hair growth pathways while suppressing fibrosis and inflammation markers. These findings provide a rationale for future clinical trials studying metformin as a targeted therapy for CCCA and other cicatricial alopecias.
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Affiliation(s)
- Aaron Bao
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aasheen Qadri
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aditi Gadre
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Georgetown University School of Medicine, Washington, DC
| | - Elizabeth Will
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dina Collins
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rexford Ahima
- Division of Endocrinology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lindsey A Bordone
- Columbia University Irving Medical Center of Medicine, New York, New York
| | - Crystal Aguh
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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2
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Geisler AN, Taye M, Larrondo J, Mayo TT, Aguh C, McMichael A, MacKelfresh JB, Krueger L. Updates on disorders in curly hair. Int J Dermatol 2024; 63:1145-1154. [PMID: 38622785 DOI: 10.1111/ijd.17184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/17/2024]
Abstract
Hair disorders, including central centrifugal cicatricial alopecia (CCCA), traction alopecia (TA), and acquired trichorrhexis nodosa (ATN), commonly occur in individuals with curly textured hair. Curly textured hair in individuals of African descent has unique properties and can present diagnostic and therapeutic challenges. CCCA has been linked to uterine leiomyoma and type 2 diabetes mellitus, as well as fibroproliferation. TA often presents with a fringe sign and can arise from high-tension hairstyles presumed to be protective. Trichoscopy is useful in establishing a diagnosis; perifollicular halos are more commonly seen than perifollicular erythema or scale in CCCA. In TA, miniaturized follicles, hair casts, and "flambeau sign" can be seen. Hairstyling practices likely contribute to TA and ATN; however, the data are mixed on the role of chemical relaxers and heat styling in CCCA. Unique considerations in the presentation of frontal fibrosing alopecia in curly textured hair have also been published recently. This review provides a comprehensive, up-to-date summary of these disorders with an emphasis on their unique properties, as well as considerations in hair care for curly textured hair.
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Affiliation(s)
- Amaris N Geisler
- Department of Dermatology, Emory University School of Medicine, Atlanta, USA
| | - Marta Taye
- Department of Dermatology, Emory University School of Medicine, Atlanta, USA
| | - Jorge Larrondo
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Tiffany T Mayo
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, USA
| | - Crystal Aguh
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, USA
| | - Amy McMichael
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Jamie B MacKelfresh
- Department of Dermatology, Emory University School of Medicine, Atlanta, USA
| | - Loren Krueger
- Department of Dermatology, Emory University School of Medicine, Atlanta, USA
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3
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Granja BV, De Matos PR, Rosa GP, Pinheiro J, Azevedo F, Pedrosa AF. Treatment of central centrifugal cicatricial alopecia with topical metformin 10% cream: case report and literature review. Int J Dermatol 2024. [PMID: 38923417 DOI: 10.1111/ijd.17345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Bárbara Vieira Granja
- Department of Dermatology and Venereology, Unidade Local de Saúde São João, Porto, Portugal
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Rolo De Matos
- Department of Dermatology and Venereology, Unidade Local de Saúde São João, Porto, Portugal
| | - Gilberto Pires Rosa
- Department of Dermatology and Venereology, Unidade Local de Saúde São João, Porto, Portugal
- RISE@CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jorge Pinheiro
- Department of Pathology, Unidade Local de Saúde São João, Porto, Portugal
| | - Filomena Azevedo
- Department of Dermatology and Venereology, Unidade Local de Saúde São João, Porto, Portugal
| | - Ana Filipa Pedrosa
- Department of Dermatology and Venereology, Unidade Local de Saúde São João, Porto, Portugal
- RISE@CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal
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4
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Jackson T, Sow Y, Dinkins J, Aguh C, Omueti Ayoade K, Barbosa V, Burgess C, Callender V, Cotsarelis G, Grimes P, Harvey V, Kindred C, Lester J, Lo Sicco K, Mayo T, McMichael A, Oboite M, Ogunleye T, Olsen E, Osei-Tutu A, Piliang M, Senna M, Shapiro J, Tosti A, Frey C, Adotama P, Taylor SC. Treatment for central centrifugal cicatricial alopecia-Delphi consensus recommendations. J Am Acad Dermatol 2024; 90:1182-1189. [PMID: 38341148 DOI: 10.1016/j.jaad.2023.12.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/30/2023] [Accepted: 12/23/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND There is no established standard of care for treating central centrifugal cicatricial alopecia (CCCA), and treatment approaches vary widely. OBJECTIVE To develop consensus statements regarding the use of various pharmacological therapies in treating adults with CCCA. METHODS We invited 27 dermatologists with expertise in hair and scalp disorders to participate in a 3-round modified Delphi study between January and March 2023. Statements met strong consensus if 75% of respondents agreed or disagreed. Statements met moderate consensus if 55% or more but less than 75% agreed or disagreed. RESULTS In round 1, 5 of 33 (15.2%) statements met strong consensus, followed by 9 of 28 (32.1%) in round 2. After the final round 3 meeting, strong consensus was reached for 20 of 70 (28.6%) overall statements. Two statements achieved moderate consensus. LIMITATIONS This study included only English-speaking, US-based dermatologists and did not consider nonpharmacological therapies. CONCLUSION Despite varying opinions among dermatologists, consensus was reached for several statements to help clinicians manage CCCA. We also highlight areas that lack expert consensus with the goal of advancing research and therapeutic options for CCCA.
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Affiliation(s)
| | - Yacine Sow
- Morehouse School of Medicine, Atlanta, Georgia
| | | | - Crystal Aguh
- Department of Dermatology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Katherine Omueti Ayoade
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Victoria Barbosa
- Section of Dermatology, University of Chicago Medicine, Chicago, Illinois
| | - Cheryl Burgess
- Center for Dermatology and Dermatologic Surgery, Washington, District of Columbia
| | | | - George Cotsarelis
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pearl Grimes
- Grimes Center for Medical and Aesthetic Dermatology, Vitiligo and Pigmentation Institute of Southern California, Los Angeles, California
| | - Valerie Harvey
- Tidewater Physicians Multispecialty Group, Virginia Beach, Virginia; Hampton Roads Center for Dermatology, Newport News, Virginia
| | | | - Jenna Lester
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York
| | - Tiffany Mayo
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Amy McMichael
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Michelle Oboite
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Temitayo Ogunleye
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elise Olsen
- Department of Dermatology, Duke University, Durham, North Carolina
| | | | - Melissa Piliang
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Maryanne Senna
- Lahey Hair Loss Center of Excellence and Research Unit, Burlington, Massachusetts
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York
| | - Antonella Tosti
- Department of Dermatology, University of Miami, Miami, Florida
| | - Cheri Frey
- Department of Dermatology, Howard University, Washington, District of Columbia
| | - Prince Adotama
- The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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5
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Gadre A, Dyson T, Jedrych J, Anhalt G, Byrd AS, Aguh C. Proteomic Profiling of Central Centrifugal Cicatricial Alopecia Reveals Role of Humoral Immune Response Pathway and Metabolic Dysregulation. JID INNOVATIONS 2024; 4:100263. [PMID: 38585195 PMCID: PMC10995914 DOI: 10.1016/j.xjidi.2024.100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 04/09/2024] Open
Abstract
Proteomic profiling on other primary cicatricial alopecias, such as frontal fibrosing alopecia and lichen planopilaris, have suggested a T helper 1-mediated inflammatory pathway, but in central centrifugal cicatricial alopecia (CCCA), the protein expression patterns are unknown. In this study, we sought to characterize protein expression patterns in CCCA to identify biomarkers of disease activity that will identify potential therapeutic avenues for treatment. Scalp protein quantification was performed to understand protein expression patterns in affected versus unaffected scalps in CCCA. A total of 5444 proteins were identified, of which 148 proteins were found to be differentially expressed in CCCA-affected scalp, with upregulation of adaptive immune pathways (IGHG3, P = .034; IGHG4, P = .01; IGG1, P = .026) and markers of fibrosis (ITGA1, P = .016; SFRP2, P = .045; TPM2, P = .029; SLMAP, P = .016) and downregulation of metabolic proteins (ALOX15B, P = .003; FADS2, P = .006; ELOVL5, P = .007; FA2H, P = .017; FAR2, P = .011; SC5D, P < .001). Our analysis revealed, to our knowledge, previously unknown humoral immune canonical pathways, notably IgG, implicated in CCCA and additionally confirmed aberrant lipid metabolism pathways implicated in diabetes mellitus, suggesting unique mechanisms of disease in patients with CCCA.
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Affiliation(s)
- Aditi Gadre
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Taylor Dyson
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Jaroslaw Jedrych
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Grant Anhalt
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Angel S. Byrd
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Dermatology, College of Medicine, Howard University, Washington, District of Columbia, USA
| | - Crystal Aguh
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Fatima SZ. Central centrifugal cicatricial alopecia: a deeper insight into the disease. Wien Med Wochenschr 2024:10.1007/s10354-024-01033-z. [PMID: 38383911 DOI: 10.1007/s10354-024-01033-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/15/2024] [Indexed: 02/23/2024]
Abstract
Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia of multifactorial etiology that presents on the vertex as patchy areas of hair loss, spreading centrifugally over the scalp. It most commonly affects women of African descent, but cases among other ethnicities have also been reported. CCCA typically starts with thinning and breaking of the hair as the first sign of presentation, which eventually progresses to hair loss over the central part of the scalp, spreading symmetrically outwards to involve a larger area. Currently, there is no definitive cure for the disease; however, multiple management options are available, which should aim to be tailored to the individual patient. Owing to its cosmetic outcomes, the quality of life (QoL) of patients with central centrifugal cicatricial alopecia is also disturbed, as patients may face psychological and social stress due to their permanent hair loss. This article focuses on various aspects of the pathogenesis, clinical trials, quality of life, barriers faced by patients, and treatment of central centrifugal cicatricial alopecia.
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Affiliation(s)
- Syeda Zainab Fatima
- Dow University of Health Sciences, Baba-E-Urdu Road, 74200, Karachi, Pakistan.
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7
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El-Komy MHM, Abdo NMK, Shamma RN, Bedair NI. Topical metformin 30% gel in the treatment of acne vulgaris in women, a split face, placebo-controlled study. Exp Dermatol 2023; 32:1663-1673. [PMID: 37357907 DOI: 10.1111/exd.14868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Abstract
Acne vulgaris (AV), a widely common disorder, that negatively affects the quality of life. Metformin is a relatively safe, cheap and well tolerated drug that is widely used in the treatment of Diabetes. Systemic metformin has demonstrated promising results in treating acne, while topically it was studied for melasma and recalcitrant central centrifugal cicatricial alopecia. To study the safety and efficacy of topical metformin 30% in the treatment of AV. Twenty-seven female AV patients were asked to blindly apply metformin and placebo gels to either side of the face for 12 weeks. AV lesion count was performed at baseline, at each visit and 4 weeks after end of treatment. At the end of the treatment period, the treated side showed significant improvement of comedones, papules and nodules but not pustules. Although, lesions count increased 1 month after stopping treatment, comedones and papules numbers were still significantly less on the metformin side compared to placebo. No side effects were reported. The limited number of patients studied and the limited follow-up period. The metformin effect was not studied on cellular and molecular levels. Topical metformin nanoemulsion gel can be a promising safe and effective treatment of AV.
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Affiliation(s)
- Mohamed H M El-Komy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Rehab Nabil Shamma
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Nermeen Ibrahim Bedair
- Department of Dermatology, Andrology, Sexual Medicine and STDs, Faculty of Medicine, Helwan University, Helwan, Egypt
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8
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Onamusi T, Larrondo J, McMichael AJ. Clinical factors and hair care practices influencing outcomes in central centrifugal cicatricial alopecia. Arch Dermatol Res 2023; 315:2375-2381. [PMID: 37188887 DOI: 10.1007/s00403-023-02630-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
Central centrifugal cicatricial alopecia (CCCA) is the most common form of primary scarring alopecia in women of African descent, negatively impacting their quality of life. Treatment is often challenging, and we usually direct therapy to suppress and prevent the inflammation. However, factors affecting clinical outcomes are still unknown. To characterize medical features, concurrent medical conditions, hair care practices, and treatments used for patients with CCCA and assess their relationship with treatment outcomes. We analyzed data from a retrospective chart review of 100 patients diagnosed with CCCA who received treatment for at least one year. Treatment outcomes were compared with patient characteristics to determine any relationships. P-values were calculated using logistic regression and univariate analysis with 95% CI P < 0.05 was considered significant. After one year of treatment, 50% of patients were stable, 36% improved, and 14% worsened. Patients without a history of thyroid disease (P = 0.0422), using metformin for diabetes control (P = 0.0255), using hooded dryers (P = 0.0062), wearing natural hairstyles (P = 0.0103), and having no other physical signs besides cicatricial alopecia (P = 0.0228), had higher odds of improvement after treatment. Patients with scaling (P = 0.0095) or pustules (P = 0.0325) had higher odds of worsening. Patients with a history of thyroid disease (P = 0.0188), not using hooded dryers (0.0438), or not wearing natural hairstyles (P = 0.0098) had higher odds of remaining stable. Clinical characteristics, concurrent medical conditions, and hair care practices may affect clinical outcomes after treatment. With this information, providers can adjust proper therapies and evaluations for patients with Central centrifugal cicatricial alopecia.
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Affiliation(s)
- Toluwalashe Onamusi
- , Nashville, USA
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
| | - Jorge Larrondo
- Department of Dermatology, Wake Forest School of Medicine, 4618 Country Club Rd, Winston Salem, NC, 27104, USA
- Department of Dermatology, Clinica Alemana-Universided del Desarrollo, Santiago, Chile
| | - Amy J McMichael
- Department of Dermatology, Wake Forest School of Medicine, 4618 Country Club Rd, Winston Salem, NC, 27104, USA.
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9
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Workman K, Kindred C. Hair regrowth in a patient with central centrifugal cicatricial alopecia after a 2-month trial of baricitinib. JAAD Case Rep 2023; 39:109-111. [PMID: 37664448 PMCID: PMC10468318 DOI: 10.1016/j.jdcr.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Affiliation(s)
- Kaelynn Workman
- Case Western Reserve University School of Medicine, Cleveland, Ohio
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10
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Umar S, Ton D, Carter MJ, Shitabata P. Unveiling a Shared Precursor Condition for Acne Keloidalis Nuchae and Primary Cicatricial Alopecias. Clin Cosmet Investig Dermatol 2023; 16:2315-2327. [PMID: 37649568 PMCID: PMC10464825 DOI: 10.2147/ccid.s422310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
Purpose Small observational studies suggest subclinical disease occurrence in the normal-appearing scalp zones of several primary cicatricial alopecias. To aid patient management, we began routinely evaluating the entire scalp of patients with acne keloidalis nuchae (AKN), including trichoscopy-guided biopsies. Patients and Methods This retrospective study evaluated 41 patients sequentially presenting with AKN at a single clinic between June and December 2022. Primary lesions and normal-appearing scalp in the superior parietal scalp at least 5 cm away from AKN-affected zones were clinically evaluated, and areas showing perifollicular erythema or scales/casts on trichoscopy were biopsied and histologically analyzed. Results Forty-one men with AKN, including 20 men of African descent, 17 Hispanic, and 4 European-descended Whites, were evaluated. All patients, including 22% with associated folliculitis decalvans, showed scalp-wide trichoscopy signs of perifollicular erythema or scaling in normal-appearing scalp areas. All patients showed histologic evidence of perifollicular infundibulo-isthmic lymphocytoplasmic infiltrates and fibrosis (PIILIF), with 96% showing Vellus or miniaturized hair absence. PIILIF was often clinically mistaken for seborrheic dermatitis (44-51%). All White patients had mild papular acne keloidalis nuchae lesions mistaken for seborrheic dermatitis. Conclusion PIILIF may be a precursor to a wide spectrum of primary cicatricial alopecias, including AKN and folliculitis decalvans. This finding carries implications for the early diagnosis and management of AKN and other primary cicatricial alopecias.
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Affiliation(s)
- Sanusi Umar
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
- Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA
| | - Donna Ton
- Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA
| | | | - Paul Shitabata
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
- Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- Dermatopathology Institute, Torrance, CA, USA
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11
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Ezemma O, Devjani S, Kelley KJ, Senna MM. Treatment modalities for lymphocytic and neutrophilic scarring alopecia. J Am Acad Dermatol 2023; 89:S33-S35. [PMID: 37591564 DOI: 10.1016/j.jaad.2023.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 08/19/2023]
Abstract
Primary cicatricial alopecia can result in permanent hair loss from the destruction of hair follicles. Early intervention is key in controlling disease progression, reducing symptoms, and optimizing hair density. Treatment modalities range from topical and intralesional therapies to oral medications and light therapy.
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Affiliation(s)
- Ogechi Ezemma
- Department of Dermatology, Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - Shivali Devjani
- Department of Dermatology, Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - Kristen J Kelley
- Department of Dermatology, Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - Maryanne M Senna
- Department of Dermatology, Lahey Hospital & Medical Center, Burlington, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts.
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12
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Gouveri E, Papanas N. Τhe Endless Beauty of Metformin: Does It Also Protect from Skin Aging? A Narrative Review. Adv Ther 2023; 40:1347-1356. [PMID: 36715895 DOI: 10.1007/s12325-023-02434-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
Abstract
Metformin has shown multiple effects beyond its widely known antidiabetic effect. Impressively, it has already been proposed as an anti-aging factor. However, the potentially protective role of metformin in skin aging, the most common manifestation of aging, is not well examined. Existing evidence based on experimental studies suggests a potential anti-aging effect on skin. Proposed molecular skin anti-aging mechanisms of metformin include mainly reduction of nuclear factor kappa B (NF-κB) (p65) activity. Moreover, metformin appears to inhibit ultraviolet B (UVB)-induced secretion of pro-inflammatory cytokines. Nonetheless, data is still limited, and so more studies are needed. Importantly, we need more studies conducted in humans to further examine this interesting potential. Until then, whether oral administration of metformin or local use of the agent could be used to delay skin aging remains to be answered.
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Affiliation(s)
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, 68132, Alexandroupolis, Greece.
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13
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Liu J, Zhang M, Deng D, Zhu X. The function, mechanisms, and clinical applications of metformin: potential drug, unlimited potentials. Arch Pharm Res 2023; 46:389-407. [PMID: 36964307 DOI: 10.1007/s12272-023-01445-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 03/08/2023] [Indexed: 03/26/2023]
Abstract
Metformin has been used clinically for more than 60 years. As time goes by, more and more miraculous effects of metformin beyond the clinic have been discovered and discussed. In addition to the clinically approved hypoglycemic effect, it also has a positive metabolic regulation effect on the human body that cannot be ignored. Such as anti-cancer, anti-aging, brain repair, cardiovascular protection, gastrointestinal regulation, hair growth and inhibition of thyroid nodules, and other nonclinical effects. Metformin affects almost the entire body in the situation taking it over a long period, and the preventive effects of metformin in addition to treating diabetes are also beginning to be recommended in some guidelines. This review is mainly composed of four parts: the development history of metformin, the progress of clinical efficacy, the nonclinical efficacy of metformin, and the consideration and prospect of its application.
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Affiliation(s)
- Jianhong Liu
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou Medical College, Hangzhou, China
- Department of Cardiology, The Second Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China
| | - Ming Zhang
- Department of Physical Medicine and Rehabilitation, Zibo Central Hospital, Zibo, China
| | - Dan Deng
- Department of Cardiology, The Second Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China
| | - Xiao Zhu
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou Medical College, Hangzhou, China.
- Department of Cardiology, The Second Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China.
- Guangdong Provincial Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen Key Laboratory of Genitourinary Tumor, Department of Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital (Shenzhen Institute of Translational Medicine), Shenzhen, China.
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14
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Beyond the Hot Comb: Updates in Epidemiology, Pathogenesis, and Treatment of Central Centrifugal Cicatricial Alopecia from 2011 to 2021. Am J Clin Dermatol 2023; 24:81-88. [PMID: 36399228 DOI: 10.1007/s40257-022-00740-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 11/19/2022]
Abstract
Central centrifugal cicatricial alopecia (CCCA) is a form of scarring alopecia that predominantly affects middle-aged women of African descent. Recent data suggest a multifactorial etiology of CCCA that is influenced by environmental and genetic factors. Emerging evidence regarding the genetic basis of the condition may elucidate new therapies. While topical and intralesional steroids and tetracycline antibiotics are the mainstay of treatment, refractory cases may be considered for hair transplantation. Emerging therapies using platelet-rich plasma, botanical formulas, and cosmetic procedures have shown promising results for the future management of CCA. As recent notable advances in CCCA have been achieved, this review provides an update on the epidemiology, pathophysiology, and management of CCCA.
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15
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Ali S, Collins M, Taylor SC, Kelley K, Stratton E, Senna M. Type 2 diabetes mellitus and central centrifugal cicatricial alopecia severity. J Am Acad Dermatol 2022; 87:1418-1419. [PMID: 36007690 DOI: 10.1016/j.jaad.2022.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/28/2022] [Accepted: 08/18/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Shaheir Ali
- Division of Dermatology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Maya Collins
- Division of Dermatology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristen Kelley
- Division of Dermatology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Emma Stratton
- Division of Dermatology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Maryanne Senna
- Division of Dermatology, Lahey Hospital and Medical Center, Burlington, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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16
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Modulation of autophagy, apoptosis and oxidative stress: a clue for repurposing metformin in photoaging. Inflammopharmacology 2022; 30:2521-2535. [PMID: 35913649 DOI: 10.1007/s10787-022-01041-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/15/2022] [Indexed: 11/05/2022]
Abstract
Long-term sun exposure is the commonest cause of photoaging, where mutual interplay between autophagy, oxidative stress, and apoptosis is incriminated. In combating photoaging, pharmacological approaches targeted to modulate autophagy are currently gaining more ground. This study aimed to examine repurposing metformin use in such context with or without the antioxidant coenzyme Q10 (coQ10) in ultraviolet A (UVA) irradiation-induced skin damage. The study was conducted on 70 female CD1 mice that were randomly assigned into seven groups (10/group): normal control, vehicle-treated-UVA-exposed mice, three metformin UVA-exposed groups (Topical 1 and 10%, and oral 300 mg/kg), topical coQ10 (1%)-treated mice, and combined oral metformin with topical coQ10-treated UVA-exposed mice. After UVA-exposure for 10 weeks (3 times/week), macroscopic signs of photoaging were evaluated. Mice were then euthanized, and the skin was harvested for biochemical estimation of markers for oxidative stress, inflammation, matrix breakdown, and lysosomal function. Histopathological signs of photoaging were also evaluated with immunohistochemical detection of associated changes in autophagic and apoptotic markers. Metformin, mainly by topical application, improved clinical and histologic signs of photoaging. This was associated with suppression of the elevated oxidative stress, IL-6, matrix metalloproteinase 1, and caspase, with induction of cathepsin D and subsequent change in anti-LC3 and P62 staining in skin tissue. In addition to metformin antioxidant, anti-inflammatory, and antiapoptotic activities, its anti-photoaging effect is mainly attributed to enhancing autophagic flux by inducing cathepsin D. Its protective effect is boosted by coQ10, which supports their potential use in photoaging.
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17
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Umar S, Kan P, Carter MJ, Shitabata P. Treatment-Refractory Central Centrifugal Cicatricial Alopecia Responsive to a Novel Botanical Treatment. Clin Cosmet Investig Dermatol 2022; 15:609-619. [PMID: 35422647 PMCID: PMC9004676 DOI: 10.2147/ccid.s358618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/31/2022] [Indexed: 01/06/2023]
Abstract
Purpose Central centrifugal cicatricial alopecia (CCCA) is the most common cause of scarring alopecia in women of African descent. However, current treatments for CCCA, such as immunosuppressants and immunomodulatory pharmaceutical agents, have suboptimal efficacy and undesirable side effects. This case series reports the therapeutic effect of a new botanical formulation (Dr. UGro Gashee) in four patients with histologically supported diagnoses of CCCA. The formulations contain at least three phytoactive ingredients that affect multiple targets in the cascade of pathophysiologic events contributing to CCCA. Possible mechanisms of action include anti-inflammatory effects, inhibiting proinflammatory cytokines, and the net antifibrotic effect of inhibiting transforming growth factor-beta while upregulating AMP-activated protein kinase and peroxisome proliferator-associated receptor-gamma activity. Patients and Methods Four African American women with treatment-refractory CCCA were treated with a new topical botanical formula (cosmeceutical) alone or in combination with its oral formulation (nutraceutical) for 8 weeks to 1 year. The cosmeceutical and nutraceutical treatments contain similar phytoactive ingredient profiles. Treatment outcomes were collected using documented patient reports and images and by direct observation. Results In all patients, scalp pruritus cessation occurred within 2 weeks of treatment, and significant hair regrowth was observed within 2 months. All patients reported a high satisfaction level without adverse effects. Conclusion Patients with treatment-refractory CCCA responded to the novel botanical treatment reported in this study. Further evaluations in a controlled trial with more patients are warranted.
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Affiliation(s)
- Sanusi Umar
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.,Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA.,Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA
| | - Petrina Kan
- Department of Molecular Biology, University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Paul Shitabata
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.,Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA.,Dermatopathology Institute, Torrance, CA, USA
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18
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19
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Sun C, Hu SH, Dong BQ, Jiang S, Miao F, Lei TC. Metformin Promotes the Hair-Inductive Activity of Three-Dimensional Aggregates of Epidermal and Dermal Cells Self-Assembled In Vitro. Skin Pharmacol Physiol 2021; 35:137-147. [PMID: 34883492 DOI: 10.1159/000521400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 12/07/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although it has been reported that the anti-diabetic drug metformin has multiple extra-hypoglycemic activities, such as anti-oxidation, anti-aging and even anti-tumor, topical metformin also can induce hair regeneration, but the precise mechanism involved in that process is still unclear. OBJECTIVES To assess the effect of metformin on hair growth in a mouse hair follicle reconstitution model generated by in vitro self-assembled three-dimensional aggregates of epidermal and dermal cells (3D aggregates). METHODS Epidermal cells and dermal cells were isolated and cultured from the mouse skin of fifty C57BL/6 mouse pups (1-day-old). For tracing the distribution of dermal cells during the self-assembly process of 3D aggregates, the dermal cells were labeled with Vybrant Dil cell-labelling solution and mixed with epidermal cells at 1:1 ratio. Formed 3D aggregates were treated with 10 mM metformin and then were grafted into recipient BALB/c nude mice. The biomarkers (HGF, CD133, ALP, β-catenin and SOX2) associated with the hair-inductive activity of dermal cells were detected in the grafted skin tissues and in cultured 3D aggregates treated with metformin using immunofluorescent staining, quantitative real-time RT-PCR (qRT-PCR), and western blotting. Furthermore, the expression levels of CD133 were also examined in dermal cells with different passage numbers using qRT-PCR and western blotting. RESULTS Metformin directly stimulates the activity of alkaline phosphatase (ALP) of cultured 3D aggregates, upregulates both the protein and mRNA expression levels of molecular markers (HGF, CD133, ALP, β-catenin and SOX2) and improves the survival rate of reconstituted hair follicles. Moreover, we also found that metformin increases the expression of CD133 in dermal cells thus maintaining their trichogenic capacity that would normally be lost by serial subculture. CONCLUSIONS These results suggest that metformin can promote hair follicle regeneration in vitro through up-regulation of the hair inductive capability of dermal cells, warranting further evaluation in the clinical treatment of male or female pattern hair loss.
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Affiliation(s)
- Chao Sun
- Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, China,
| | - Shuang-Hai Hu
- Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bing-Qi Dong
- Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shan Jiang
- Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Fang Miao
- Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tie-Chi Lei
- Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, China
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20
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Compatibility of Different Formulations in Pentravan® and Pentravan® Plus for Transdermal Drug Delivery. Sci Pharm 2021. [DOI: 10.3390/scipharm89040051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The potential therapeutic benefit of transdermal delivery systems for some active pharmaceutical ingredients (APIs) has been well-established for decades within the scientific community. However, together with the clinical efficacy, there is the need for an evaluation of the stability of such APIs in bases with known transdermal capabilities, which is necessary to provide the compounding pharmacist with confidence when providing transdermal products. In this study, the stability of danazol, metformin HCl, and resveratrol as individual ingredients, as well as metformin HCl, resveratrol, and Vitamin D3 in combinations at bracketed high and low concentrations, were evaluated over a period of 6 months, using a ready-to-use transdermal vehicle for compounding pharmacies (Pentravan® or Pentravan® Plus). The five formulations tested (F1: Danazol 50 mg/g + MiodesinTM 85 mg/g in Pentravan®, F2: Metformin HCl 200 mg/g in Pentravan®, F3: Resveratrol 200 mg/g in Pentravan®, F4: Metformin HCl 100 mg/g + Resveratrol 100 mg/g + Vitamin D3 5000 IU in Pentravan®, and F5: Metformin HCl 200 mg/g + Resveratrol 200 mg/g + Vitamin D3 5000 IU in Pentravan® Plus) presented a beyond-use date of at least 6 months, presenting high convenience for the compounding pharmacies.
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Abstract
Alopecia is a dermatologic condition in which sudden or gradual loss of hair occurs on 1 or more areas of the body, most commonly the scalp. Hair loss can be acute or chronic in nature as a result of underlying inflammation, autoimmune processes, stressors, chemotherapy, or hairstyling practices. Alopecia can have substantial psychological consequences, having a negative impact on the quality of life in affected patients. The ability to both recognize and distinguish these condition holds great significance not only in providing adequate and timely treatment to improve outcomes but also meeting patient needs.
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Affiliation(s)
- Taylor A Jamerson
- University of Michigan Medical School, 1050 Wall Street, Apartment 2D, Ann Arbor, MI 48105, USA
| | - Crystal Aguh
- Department of Dermatology, Johns Hopkins University School of Medicine, 10710 Charter Drive, Shared Suite 420, Baltimore, MD 21044, USA.
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22
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Lawson CN, Bakayoko A, Callender VD. Central Centrifugal Cicatricial Alopecia: Challenges and Treatments. Dermatol Clin 2021; 39:389-405. [PMID: 34053593 DOI: 10.1016/j.det.2021.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Central centrifugal cicatricial alopecia (CCCA) is the most common form of primary scarring alopecia diagnosed in women of African descent. Although the etiology was originally attributed exclusively to hairstyling practices common among women of African descent, more recent research on CCCA supports the concept that there are several contributing factors, including variants in gene expression, hair grooming practices that increase fragility on the hair follicle, and associations with other systemic conditions. Treatment of CCCA involves a combination of patient counseling and education on alternative hairstyles, medical therapies, and procedural methods when necessary.
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Affiliation(s)
- Christina N Lawson
- Dermatology Associates of Lancaster, 1650 Crooked Oak Drive, Suite 200, Lancaster, PA 17601, USA.
| | - Awa Bakayoko
- Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
| | - Valerie D Callender
- Callender Dermatology and Cosmetic Center, 12200 Annapolis Road, Suite 315, Glenn Dale, MD 20769, USA
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23
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Poliner AD, Tosti A. Hair regrowth in cicatricial alopecia: A literature review. J Dermatol 2021; 48:1113-1128. [PMID: 33890315 DOI: 10.1111/1346-8138.15902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/18/2021] [Indexed: 01/06/2023]
Abstract
Cicatricial alopecias (CA) describes multiple subtypes of hair loss in which the hair follicle is destroyed by an unknown inflammatory mechanism. The main goal of treatment is to stop this inflammatory process and prevent further hair loss; however, there have been occasional reports of hair regrowth following treatment in some subtypes of CA. This review aims to highlight these reports. A total of 71 cases of hair regrowth were found documented in the literature. The treatments used varied widely both between and within each subtype of alopecia. This review highlights that regrowth is possible in at least a subset of patients with cicatricial alopecia; however, the mechanism by which this occurs has yet to be elucidated.
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Affiliation(s)
- Anna D Poliner
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida, USA
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