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). 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). Metformin, commonly used for glycemic control in type 2 diabetes, has shown efficacy in improving fibrosis in a mouse model of FPD through the mediation of adenosine monophosphate–activated protein kinase (AMPK). We present 2 cases of hair regrowth after topical use of metformin for CCCA. Dissecting cellulitis of the scalp (DCS), also referred to as perifolliculitis capitis abscedens et suffodiens, is an uncommon primary neutrophilic cicatricial alopecia. DCS is characterized by perifollicular and follicular pustules that evolve into areas of noncicatricial alopecia resembling different scalp diseases. DCS can develop painful nodules and interconnected abscesses and, in the end stages, permanent alopecia. DCS can occur with follicular occlusion diseases; therefore, the term dissecting terminal hair folliculitis has been recently proposed.¹ The etiology of the disease remains unknown. The male dominance, together with the young age of onset and the vertex area suggest a hormonal risk factor. On the other hand, significant prevalence in dark photo-type individuals and a few cases of familiar DCS propose a genetic background.^2,3 We report a unique case of DCS in monozygous twins.

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Hair Therapy and Transplantation

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