Hair regrowth in 2 patients with recalcitrant central centrifugal cicatricial alopecia after use of topical metformin

Central centrifugal cicatricial alopecia (CCCA) is a progressive scarring alopecia predominately occurring in women of African descent.1 The progression of hair loss is insidious, often occurring in the absence of clinical signs of overt inflammation. As a result, end stage fibrosis occurs at a rate disproportionate to the rate of inflammation, a finding common to a class of disorders termed fibroproliferative disorders (FPDs).2 Staging of CCCA is based on distribution, frontal (type a) or vertex (type b) location, and extent of the area of affected scalp scaled numerically from normal (0) to bald scalp (5).