Metformin is an oral medication primarily used in the management of Type 2 Diabetes Mellitus (T2DM), a condition that affects over 422 million individuals globally¹. Its increasing prevalence is associated with sedentary lifestyles and rising rates of obesity, particularly in developed and developing countries. As a member of the biguanide class of drugs, metformin works by reducing hepatic glucose production, improving insulin sensitivity, and increasing peripheral glucose uptake². This mechanism allows for effective glucose control without significant risk of hypoglycemia, making it a cornerstone treatment in diabetes management³.
Metformin’s Role in Treating Androgenic Alopecia
Beyond its role in metabolic disorders, metformin has a well-established function in treating androgenic alopecia, a common form of hair loss. This condition is driven by elevated levels of dihydrotestosterone (DHT), especially in individuals with insulin resistance, such as those with polycystic ovary syndrome (PCOS)⁴. By improving insulin sensitivity, metformin helps to reduce circulating androgen levels, which in turn may slow or reverse hair follicle miniaturization. This process is key in treating androgenic alopecia, as it supports hair regrowth⁵ and mitigates further hair loss. Metformin’s therapeutic efficacy in androgenic alopecia is now recognized as a beneficial option in clinical settings.
Emerging Evidence for Metformin in Central Centrifugal Cicatricial Alopecia (CCCA)
In addition to its established benefits for androgenic alopecia, recent evidence suggests that metformin may be effective in treating a newly recognized form of hair loss known as central centrifugal cicatricial alopecia (CCCA). This type of scarring alopecia, which disproportionately affects Black women, was not previously known to respond to metformin. A recent clinical case series⁶ has shown promising results for metformin in managing CCCA.
In a study involving 12 Black female participants with biopsy-confirmed CCCA that had been resistant to standard treatments, participants were treated with extended-release metformin (500 mg once daily) in addition to their baseline therapies. The results revealed that 75% of participants experienced improvement in symptoms such as scalp pain, inflammation, and pruritus. Furthermore, 50% of participants demonstrated clinical evidence of hair regrowth⁶ after six months of treatment.
Transcriptomic and Gene Analysis Findings in Metformin Treatment
Transcriptomic analysis from the study provided further insights into metformin’s effects on CCCA. The drug upregulated pathways involved in keratinization and epidermal development, while downregulated pathways associated with fibrosis. The gene set variation analysis (GSVA) revealed a reduction in helper T cell 17 (TH17) and epithelial-mesenchymal transition pathways, coupled with an increase in AMPK signaling and the expression of KRTAP (keratin-associated protein) genes. These findings suggest that low-dose metformin can potentially reverse the fibrotic transcriptional signature in CCCA and promote hair regrowth⁶.
Conclusion and Key Takeaways on Metformin’s Therapeutic Applications
Metformin’s established benefits in managing androgenic alopecia and its emerging potential in treating CCCA underscore its broader applications beyond diabetes management. While promising, these findings on CCCA require further validation through larger, randomized controlled trials to determine metformin’s long-term efficacy and optimal dosing in cicatricial alopecia cases. Its ability to influence both metabolic and dermatological conditions highlights metformin’s therapeutic versatility and its role in improving patient outcomes across various domains.
