Central Centrifugal Cicatricial Alopecia: Which patients are more likely to improve with treatment?

Natural Hairstyles, Metformin Use, Hood Dryers and Good Health Predict Good Outcomes in CCCA

Authors of a new study set out to determine factors associated with good treatment outcomes among patients with CCCA. The authors performed a retrospective chart review involving 100 patients with CCCA who received treatment for at least 12 months. After completing one year of treatment, 50% of patients were stable, 36% improved, and 14% worsened.

Patients have a higher odds of achieving an improvement had the following characteristics:

No history of thyroid disease (P = 0.0422)

Used metformin for diabetes control (P = 0.0255)

Used hooded dryers (P = 0.0062)

Wore natural hairstyles (P = 0.0103)

Had no other physical signs besides cicatricial alopecia (P = 0.0228)

Interesting, patients with scaling (P = 0.0095) or pustules (P = 0.0325) had higher odds of having a worsening in their hair after 12 months of treatment.

Comment

This is an interesting study. First, it again brings up the use of metformin in treating CCCA and whether this in fact should explored even more than it is now. We reviewed the possible use of metformin for CCCA a few years ago. It seems this fairly safe treatment really needs more study.

Second, it again bring us back to whether or not we should we encouraging patients to wear natural hairstyles with a CCCA diagnosis. I’ve generally been of the opinion that for CCCA - 6 to 12 months of doing less is really important. I was very interested to see that women wearing natural hairstyles had a higher chance of achieving an improvement.

REFERENCE

Toluwalashe Onamusi et al. Clinical factors and hair care practices influencing outcomes in central centrifugal cicatricial alopecia. Arch Dermatol Res. 2023 May 15. doi: 10.1007/s00403-023-02630-5. Online ahead of print.