Pioglitazone reverses hair loss in patient with cicatricial alopecia: Case report

The unique case showed dramatic hair regrowth in patients with twice biopsy-confirmed cicatricial alopecia. The case is the first to describe hair regrowth in cicatricial alopecia linked with pioglitazone addition.

According to the authors, pioglitazone was the primary contributor to hair regrowth in cicatricial alopecia; this is because regrowth was observed four months after pioglitazone incorporation and failure to prior therapies to control disease activity.

"This case established that hair regrowth is possible with treatment. However, further studies are warranted into the inflammatory process underlying disease pathogenesis to explain how these treatments work to cause regrowth in scarred areas," the authors wrote.

Cicatricial alopecia is a type of hair loss in which inflammation targets and ultimately destroys the hair follicle, leading to the loss of follicular ostia. No cure exists; however, current first-line treatments aim to terminate the inflammatory process for further hair loss prevention and ease symptoms. The treatments include immunosuppressants, topical and intralesional corticosteroids, and 5-α reductase inhibitors. Additional medications, including pioglitazone, are considered adjuvant therapies in cases of failure of first-line therapies fail to control disease progression and alleviate symptoms.

Due to the conditions' permanent destruction of multipotent follicular stem cells, hair growth is unexpected during the treatment course. In patients with cicatricial alopecia, rare cases of hair regrowth have been sporadically reported.

The case described by Maria Karim, Hackensack Meridian School of Medicine, Nutley, New Jersey, and colleagues is of a 52-year-old female with a history of hypothyroidism, basal cell carcinoma, and anemia who presented at a clinic for evaluation of biopsy-confirmed LPP.

At the 6-month follow-up, the patient was initiated on oral pioglitazone 30 mg daily and began using a near monochromatic low-level laser therapy device every other day. After six weeks, her symptoms remained with continued hair loss and scalp pruritus, prompting the initiation of oral methotrexate 15 mg once weekly combined with a folic acid 1-mg supplement. After one month, she showed minimal improvement with mild residual itching, prompting methotrexate discontinuation. Three months later, she led a remarkable increase in hair density at the previously alopecic scarred area, and scalp pruritus also resolved. The physicians observed no signs of active inflammation on trichoscopy.

Reference:

Karim M, Klein EJ, Brinster N, Rieder E, Lo Sicco K, Shapiro J. Reversible hair loss in a patient with cicatricial alopecia: A case of regrowth associated with pioglitazone use. JAAD Case Rep. 2022 Aug 10;28:21-23. doi: 10.1016/j.jdcr.2022.07.038. PMID: 36090197; PMCID: PMC9459670.