Bridging Education Gaps in Treatment for Scarring Alopecia With Innovative Approaches

This content was produced independently by The American Journal of Managed Care® (AJMC®) and is not endorsed by the American Academy of Dermatology.

Crystal Aguh, MD, FAAD, Johns Hopkins School of Medicine faculty, emphasized the critical need for improved public and medical education regarding hair loss, particularly concerning the varying risks associated with different curl patterns and styling practices. She highlighted her team's groundbreaking research on central centrifugal cicatricial alopecia (CCCA), explaining it as a systemic disease linked to internal conditions like fibroids, rather than solely hair styling practices.

Aguh also discussed the evolution of CCCA research, emphasizing the importance of understanding inflammatory pathways to develop targeted therapies, moving away from past misconceptions and towards more effective, research-driven treatments.

This transcript was lightly edited for clarity; captions were auto-generated.

Transcript

How can we better educate the general public, and the medical community about the different hair types that experience hair loss?

The risk of hair loss, especially as it pertains to hair loss from hair styling practices, really increases significantly in curlier hair types. I try to tell patients and practitioners that all curly hair is not the same. Hair that's a little bit more loosely curled tends to be a little bit more resilient and less likely to experience severe breakage.

I think we need a broader public health campaign around this. Even among Black women, we're going to see a huge variety of the curl pattern and the risk of alopecia from these styling practices. It's all about education, education, education. I have a ton of education materials on my website, just because I know that I can only treat a small swath of the population, but so many people are looking for this information, and I just think education is so important.

What are the most significant recent breakthroughs that have changed your clinical practice, and what areas do you see as the most promising for future development?

I would say the most significant breakthrough would probably be some research work that my team recently did. We study a form of hair loss called CCCA [central centrifugal cicatricial alopecia]. It is a form of permanent scarring alopecia that predominantly affects Black women.

For years, for decades, we just attributed this to hair styling practices, and now we know, that it's not actually associated with hair styling practices, but can be a reflection of an internal disease. We've done a lot of research work to show its overlap with other diseases of abnormal scarring, like fibroids. We see a higher rate of fibroids in these patients than in Black women without this form of hair loss.

Recently, our team did a research study where we looked at the impact of metformin or diabetes medication in treating these patients, and a substantial percentage of patients experienced regrowth in their hair loss while on low-dose metformin. I think, if I say the biggest breakthrough, it's really understanding CCCA is a full-body disease and not a disease that's just limited to the scalp.

How has the understanding of the inflammatory pathways involved in CCCA evolved, and how is this translating into the development of more targeted therapies?

Ten years ago, there was very little research into CCCA at all. If you tell women, "You're just doing it to yourself," then that means you don't have to study it. That has really changed.

As we've done more research studies and gene expression profiling, we know more about the type of inflammation in the scalp, and we know a lot more about the type of scarring that we see in the scalp as well. The more we continue to learn about the exact inflammatory pathways that are associated with this disease, the better we are going to get at establishing medications that directly target the root of the disease.