AAD
Author: Willhemenia Loremipsum Special session: Lorem ipsum dolor sit amet Category: Lorem ipsum View all results

Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

  • Presentation

Future Treatments in Scarring Alopecia: Metabolic Influences and the Use of GLP-1 RAs in Treating Primary Cicatricial Alopecias

Description

In a presentation by Lindsay Bourdon from Columbia University, the focus is on the metabolic influences on primary cicatricial alopecias (PCA) and the potential benefits of GLP-1 receptor agonists (GLP-1 RAs) as treatment options. Bourdon explains the mechanisms of insulin resistance and hyperinsulinemia, emphasizing their roles in blood flow and fibrosis. Recent studies suggest a relationship between type 2 diabetes and conditions like Central Centrifugal Cicatricial Alopecia (CCCA). Bourdon discusses the effects of metabolic medications like metformin and GLP-1 RAs in improving hair loss related to inflammation and fibrosis. The presentation highlights the importance of understanding a patient's insulin resistance by recommending metabolic testing. Results from these tests can guide treatment, including using metformin and GLP-1 agonists to ameliorate conditions caused by insulin resistance. Key findings suggest that insulin influences the microvasculature, affecting blood supply to the scalp, which may contribute to hair loss. Bourdon illustrates how metabolic health directly correlates with skin and hair conditions, prompting the need for thorough metabolic assessments in PCA patients to achieve optimal treatment outcomes. The discussion includes insights on managing medications, potential side effects, and the necessity of lifestyle adjustments for effective treatment.

View more

Conclusions

  • Insulin resistance and hyperinsulinemia are significant factors influencing hair loss conditions.
  • Diabetes, particularly type 2, is closely linked to central centrifugal cicatricial alopecia (CCCA).
  • Low-dose metformin has shown effectiveness in decreasing pro-fibrotic signatures in CCCA patients.
  • Insulin has a vital role in promoting blood flow and may contribute to fibrosis in the body.
  • Metabolic medications can improve hair loss conditions characterized by inflammation and fibrosis.
  • Tirzepatide, a GLP-1 receptor agonist, demonstrated significant improvements in hair growth in patients with insulin resistance.
  • Hair loss in primary cicatricial alopecias may reflect systemic inflammation and fibrosis akin to non-alcoholic fatty liver disease.
  • Increased mast cells in the scalp may drive fibrotic and inflammatory responses in alopecia patients.
  • Patients with primary cicatricial alopecias should undergo metabolic assessments, including insulin resistance scoring.
  • Optimizing metabolic health is essential for effectively treating alopecia and related conditions.
  • Lindsey Bordone, MD. Assistant Professor of Dermatology COLUMBIA UNIVERSITY IRVING MEDICAL CENTER
  • Shaheir Ali, BA · Maya Collins, BS · Susan C. Taylor, MD · Kristen Kelley, BA · Emma Stratton, BSN. "Type 2 diabetes mellitus and central centrifugal cicatricial alopecia severity." RESEARCH LETTER | VOLUME 87, ISSUE 6, P1418-1419, DECEMBER 01, 2022
  • Hair regrowth in 2 patients with recalcitrant central centrifugal cicatricial alopecia after use of topical metformin. CASE REPORT | VOLUME 6, ISSUE 2, P106-108, FEBRUARY 01, 2020
  • Association of type 2 diabetes with central centrifugal cicatricial alopecia: A follow-up study. RESEARCH LETTER | VOLUME 86, ISSUE 3, P661-662, MARCH 2022
  • Aaron Bao 1, Aasheen Qadri 1, Aditi Gadre 1 2, Elizabeth Will 1, Dina Collins 1, Rexford Ahima 3, Lindsey A Bordone 4, Crystal Aguh 1. "Low-Dose Metformin and Profibrotic Signature in Central Centrifugal Cicatricial Alopecia" > JAMA Dermatol. 2024 Nov 1;160(11):1211-1219. doi: 10.1001/jamadermatol.2024.3062.
  • de Jongh, Renate T et al. "Impaired local microvascular vasodilatory effects of insulin and reduced skin microvascular vasomotion in obese women." Microvascular research vol. 75,2 (2008): 256-62. doi:10.1016/j.mvr.2007.08.001
  • Steinberg HO, Brechtel G, Johnson A, Fineberg N, Baron AD. "Insulin-mediated skeletal muscle vasodilation is nitric oxide dependent. A novel action of insulin to increase nitric oxide release." J Clin Invest. 1994;94:1172-1179.
  • Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. "Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man." Diabetologia. 1985 Jul;28(7):412-9. doi: 10.1007/BF00280883. PMID: 3899825.
  • Clark, Michael G et al. "Blood flow and muscle metabolism: a focus on insulin action." American journal of physiology. Endocrinology and metabolism vol. 284,2 (2003): E241-58. doi:10.1152/ajpendo.00408.2002
  • Clerk, Lucy H et al. "Obesity blunts insulin-mediated microvascular recruitment in human forearm muscle." Diabetes vol. 55,5 (2006): 1436-42. doi:10.2337/db05-1373
  • Keske, Michelle A et al. "Obesity blunts microvascular recruitment in human forearm muscle after a mixed meal." Diabetes care vol. 32,9 (2009): 1672-7. doi:10.2337/dc09-0206
  • de Jongh, Renate T et al. "Impaired microvascular function in obesity: implications for obesity-associated microangiopathy, hypertension, and insulin resistance." Circulation vol. 109,21 (2004): 2529-35. doi:10.1161/01.CIR.0000129772.26647.6F
  • Wallis, Michelle G et al. "Insulin-mediated hemodynamic changes are impaired in muscle of Zucker obese rats." Diabetes vol. 51,12 (2002): 3492-8. doi:10.2337/diabetes.51.12.3492
  • Rossi, M et al. "Skin blood flowmotion response to insulin iontophoresis in normal subjects." Microvascular research vol. 70,1-2 (2005): 17-22. doi:10.1016/j.mvr.2005.05.001
  • Serné, Erik H et al. "Direct evidence for insulin-induced capillary recruitment in skin of healthy subjects during physiological hyperinsulinemia." Diabetes vol. 51,5 (2002): 1515-22. doi:10.2337/diabetes.51.5.1515