Belinda Robinson has always had thick natural hair and treated her hair gently without using harsh chemicals.
But one day about 17 years ago, she noticed a small smooth spot on the back of her head. After several more years of thinning hair, she was diagnosed with a type of alopecia, a general term for hair loss.
“When I first got diagnosed, I cried, I really cried. It was hard to swallow,” said Robinson, now 53, an adjunct professor and federal employee who lives in Northern Virginia. “Now that I’m more knowledgeable about what I have, I see that many people are experiencing the same thing.”
Alopecia affects millions of Americans, and while hair can sometimes grow back naturally or with treatment, Robinson is suffering from central centrifugal cicatricial alopecia, which primarily affects black women. I was suffering from permanent hair loss called hair loss.
After several other dermatologists were of no help, a friend referred her to a doctor in Baltimore in 2022 who was testing out a hunch that a cure was hidden in plain sight. .
Dr. Crystal Agu, a dermatologist and director of the Ethnic Skin Program at Johns Hopkins University, told Robinson that about 12 black women taking a diabetes drug called metformin have been shown to slow or reverse hair loss. I asked them to check if it was possible. Agu knew that the alopecia Robinson suffered from became permanent when scarring of the scalp tissue destroyed the hair follicles.
Similar scarring is present in the organs of diabetics.
“Has anyone tried attacking scar tissue on the scalp?” she wondered. “We needed to give women a better opportunity to grow their hair.”
Agu said hair loss has a significant impact on quality of life. He said studies have shown that nearly 10% of women who need to undergo chemotherapy refuse it because of the possibility of hair loss. “The word devastating is an understatement,” she says.
According to Agu, there are two categories of hair loss. One type is the non-scarring type, which can be reversed over time, like hair loss caused by chemotherapy, and the other type can be improved with drugs such as Rogaine. The most common type, alopecia areata, which suffers from actress Jada Pinkett Smith, affects about 7 million Americans, according to the National Alopecia Areata Foundation.
Then there’s the type of scar Robinson has. Central centrifugal cicatricial alopecia is the most common of this type and may have a genetic component. Agu’s previous research has shown that up to 15% of African American women suffer from it.
She turned to the “off-label,” or unapproved, use of metformin, which is used to address dysregulation of insulin, the hormone that controls blood sugar levels and prevents organ scarring. Agu’s previous research suggested that insulin resistance also plays a role in scalp scarring.
Metformin is a relatively inexpensive drug, has been on the market for a long time, and is considered safe for long-term use. Agu had patients apply a low dose of the cream directly to their scalp.
After six to eight weeks, she observed changes in samples taken from patients’ scalps under a microscope. After six months, nine people saw improvement in their scalps, and six had some hair regrowth. She described her findings in the September 4 issue of JAMA Dermatology.
Robinson’s hair loss had stopped and she now had “peach fuzz” in her bald areas.
Agu says formal clinical trials will now be required, the process of testing the drug and gaining approval from the U.S. Food and Drug Administration. This solves the question of how much to take, in what form and for how long. Studies may also show whether the drug improves other types of hair loss.
Patients typically have to wait through a years-long testing process. However, Agu said given the drug’s safety in low doses, it could be prescribed after blood tests to check for conditions where it should not be used, such as kidney disease.
“I’m a scientist, but I’m a human being first,” she said. “I want people to get better. If you can leave a hair clinic because no one is losing hair, that’s great.”
Robinson said the metformin study gave her hope and she plans to continue taking metformin. She wants to avoid wearing wigs and means such as wigs that don’t fit her. For now, she usually wears her hair neatly tied up in a bun while she’s working.
She said she was proud to be part of the first study and hopes it will lead to a cure. She also wants other suffering people to know they are not alone.
“This happens to people of all ages and demographics,” she said. “There’s help out there. My advice is to find fun ways to style your hair and consider wigs, hats, and scarves. There are many ways to accessorize your scalp.”
