As a Black woman I’ve spent much of my life trying to find the balance between styling my hair and preserving it. Growing up I heard about and saw images of Black women whose hair had fallen out permanently after years of chemical damage, or their edges never recovered from wearing that one style that was simply too tight. We’re bombarded with too many horror stories of irreversible hair loss and too few success stories of hair recovery. It can feel like one of our most important jobs, specifically as a Black woman, is avoiding hair loss at all costs.
“Hair loss has been plaguing every race of women and men since the beginning of time,” says board-certified dermatologist Oyetewa Asempa, MD. But for Black women, the condition of our hair holds extra weight: Hair loss, whether in the form of breakage, shedding, or thinning edges, can often feel like a consequence you’ve earned by “doing too much” to your hair.
Hair loss is a universal condition, but there are some types that seem to affect Black women at higher rates than other demographics. The most well-known is probably central centrifugal cicatricial alopecia (CCCA), which was first identified in 1968 and is now one of the leading forms of hair loss among Black women.
“CCCA is one of the more common types of hair loss that we see. I treat it all day, every day,” says Meena Singh, MD, a board-certified dermatologist and dermatologic surgeon based in Mission, Kansas. “This is a type of hair loss that happens predominantly in women of African descent, and it is now, basically, an epidemic.”
Despite the condition being so common among Black women—with the frequency up to 5.6%, according to one study of Black women in the US—Crystal Aguh, MD, board-certified dermatologist, associate professor of dermatology, and director of the Ethnic Skin Program at the Johns Hopkins School of Medicine, believes research stalled on CCCA for decades because “people were so caught up in blaming patients for their own misfortune and saying, ‘You must have done something to your hair.’”
CCCA was originally believed to be caused by hair-care practices—the first study describing the condition called it “hot-comb alopecia.” But new research has discovered that genetics also play a role.
Black women, and the conditions that disproportionately affect them, have long been underrepresented in medical research. This, compounded by other factors—such as a Massachusetts Institute of Technology study that shows some dermatologists have trouble identifying conditions when it comes to Black skin—can have implications for hair loss treatment options available to Black women.
But the tide seems to be slowly turning, thanks in part to a combination of improved technologies and other developments, including initiatives like Pathways, a collaboration of the American Association of Dermatology (AAD), American Academy of Dermatology Association (AADA), Johnson & Johnson, and Kenvue, which support increased diversity and inclusivity in the dermatologic specialty.
In fact, two of the newest potential treatments for hair loss—both of which have been more widely discussed within the past five years—seem to benefit patients with CCCA, a condition that, again, affects Black patients at a higher rate. Neither of these two treatments has yet been approved by the FDA for hair loss, but a number of dermatologists seem excited by the possibilities. Here, some of those doctors share why these remedies seem so promising.
Metformin for CCCA Hair Loss
Metformin, a drug that has FDA approval to treat high blood sugar in people with type 2 diabetes, has emerged as a potential treatment option for CCCA. Dr. Aguh started formally exploring the drug's ability to treat hair loss after she observed that many of her Black women patients who exhibited scarring alopecia were also more likely to have other types of scarring, like keloids or fibroids.
“One of the first things I noticed was that these Black women who were coming in [to my practice] with this scarring hair loss were also more likely to just have scars in general, whether that was keloids or fibroids,” says Dr. Aguh. “So I did a study to see if the gene-expression pattern of CCCA was similar to some of these other scarring disorders.”
Through that research Dr. Aguh was able to identify that Metformin had also been used to treat other instances of abnormal scarring. As part of her research on hair loss, she then had the drug reformulated into a cream and prescribed it to a few patients to apply topically to the scalp.
In 2020, Dr. Aguh co-published a small study on the effects of this use of Metformin: “We published a series of two patients who had [experienced hair-growth] improvement with the [topical metformin] cream,” she recalls. “It was like, 'Wow, this is great because this is a disease where there really aren't any treatments besides steroids.'"
Dr. Aguh continues, “I started giving patients [metformin] by mouth and sampling their scalp to see how it changed the gene-expression pattern that we described years ago, and we saw a reversal of many of the [gene-expression pattern] pathways." In the study, half of the patients saw hair regrowth.
It's not uncommon for dermatologists to consider off-label use of medications for certain treatments. A representative for the AAD tells Allure, “Dermatologists care for many rare conditions, some of which have no FDA-approved treatments, [so] access to off-label prescribing is critical to care for the diverse patient populations with dermatologic disease."
Paradi Mirmirani, MD, a board-certified dermatologist at Kaiser Permanente in Northern California, says she typically takes certain factors—such as existing scientific evidence for the drug, a lack of alternative options, and the level of risk versus potential benefit to the patient—into consideration before prescribing medication for off-label use. “Reformulation of an already approved drug to make it easier for topical use is relatively common practice,” she explains. “Though I do try to make sure that the compounding pharmacy is reputable, the vehicle used for compounding is not irritating and won’t alter the drug itself, and the drug has been shown to penetrate the epidermis.”
Dr. Asempa acknowledges that there isn’t enough data yet to prove metformin can definitely treat CCCA, but she thinks the initial, albeit limited, results and the drug’s safety profile could make metformin a viable treatment option—particularly in scarring types of hair loss. “We now believe that metformin may have a chance at reversing some of the scarring seen in hair loss in certain patients,” says Dr. Asempa, adding that the medication is generally safe for most people.
While Dr. Asempa notes that hair follicles fully scarred over can’t ever be revived, “we are now placing certain patients that have scarring [alopecia] on this medication," she says, "either topically or as a pill, to see if it's going to help us reverse [some] scarring.”
Tricopat and Growth Factors
Another cutting-edge hair loss treatment making waves is a device called Tricopat, which uses a patented protocol called TRICOGENESI® to introduce growth factors into the scalp. The company says the product is specifically for treating androgenetic alopecia and telogen effluvium, though some dermatologists we spoke with say it also shows promise for use on patients with CCCA.
Tricopat has been used in Italy for years, but Achiamah Osei-Tutu, MD, a New York-based board-certified dermatologist who specializes in hair restoration, is one of the very few dermatologists in the US who have started using the device. (Dr. Osei-Tutu and Dr. Singh recently made demonstrations of Tricopat in a workshop they organized, for which Tricopat was a sponsor.)
Tricopat uses iontophoresis, which Dr. Osei-Tutu describes as a procedure that “delivers electric current to the follicles, which allows direct delivery of the growth factors to the follicle itself, where other devices may [only] deliver to the skin.” Some devices that use iontophoresis have been cleared by the FDA for the treatment of hyperhidrosis, or excessive sweating.
But Tricopat hasn’t officially arrived stateside and doesn’t appear to have FDA clearance yet. In response to questions from Allure, Tricopat representatives said they are "preparing for the official launch" of the product and would "share more information" when it was available. As of press time, the company had not responded to follow-up questions regarding FDA clearance.
While Dr. Osei-Tutu feels confident enough in the existing evidence surrounding Tricopat to recommend it for certain patients, Dr. Mirmirani is more cautious when it comes to implementing non-FDA approved devices into her practice. “I will not generally use or recommend until there is FDA clearance [for devices used for treatment of hair loss],” she says. “FDA clearance for medical devices is a much lower bar than medications since it primarily evaluates safety.”
Allure reached out to the FDA and AAD for comment about the use of medical devices that are not cleared by the FDA: The FDA did not respond to our requests; the AAD noted that the organization does not have guidelines regarding those types of devices.
Dr. Singh, however, has also integrated Tricopat into her practice and is enthusiastic about the technology. “Speaking of patients with textured hair, we have seen some really outstanding results in our patients with CCCA and traction alopecia specifically,” she says. “It's not often that we can see regrowth through the scarring and reversal of some of the breakage.”
Dr. Singh continues, “Typically it takes us eight or nine months to see any difference with anything that we're doing, but with the Tricopat, we've been seeing it within a couple treatments.” The number and frequency of treatments a patient will need depends on their specific type of hair loss, but sessions every two to four weeks for four to eight sessions seems to be the most commonly recommended range.
Since Tricopat is just making its way to the US, there’s minimal research available in the American context beyond anecdotal evidence. And in terms of clinical studies, the primary study touting the technique’s effectiveness was conducted in collaboration with the University of Bologna, which cooperated in the research project for the device. That study reported promising results, including “improvement of hair density and thickening of the hair shaft diameter in most patients.”
Dr. Osei-Tutu further emphasizes Tricopat’s relatively pain-free application, compared with other methods of delivering growth factors, like microneedling and fractional laser. “We're looking for less-invasive ways of adding growth factors to the scalp,” she explains. She also points out that, in her estimation, the device is more cost effective when compared with other kinds of in-office procedures: The downtime with Tricopat is minimal, and patients are able to get right back to normal activity, post-treatment.
Dr. Asempa has not yet used Tricopat, but she is heartened, too, by the device’s potential for pain-free delivery, and intends to be trained on it in the near future. “I've been watching my colleagues that have already been using the device and they really are reporting that their patients are saying it's completely painless,” she says. “I do injections every day in patients for hair loss, and they are very painful for some people. That can be a huge factor why some women don't get the appropriate treatment.”
The Current State of Hair Loss Treatment for Black Women
While these new hair loss solutions are especially exciting, they are just a snapshot of the many treatments being developed and adapted to promote improved hair-growth outcomes, including for Black women. In-office treatments like nanofat injections, platelet-rich plasma, or PRP, therapy (neither of which has been FDA approved for hair loss, though they have been used as a treatment for the condition for years), and of course hair transplants—as well as minoxidil and JAK inhibitors for at-home treatment—have all been shown to demonstrate varying levels of improvement in patients.
The range of treatment options available today means that dermatologists have a larger tool kit of options for treating hair loss and the chance to provide a customized treatment plan for every patient. This is why, if you are experiencing any form of hair loss, seeking out a board-certified dermatologist who specializes in hair loss should be your first stop. “Early detection is key,” says Dr. Singh. “It is far easier to prevent further hair loss than it is to regrow hair once it's gone.”
Dr. Singh and Dr. Osei-Tutu have together developed an online directory called docs4hair to help patients, specifically women of African descent, find an appropriate hair loss specialist near them. The directory aims to connect Black patients with dermatologists who have expertise in treating the hair and scalp conditions that affect Black women. The site also offers educational resources to help bridge the recognition gap for signs and symptoms of hair and scalp disorders, and to enable patients to better understand next steps for treatment.
It is important to manage expectations—as Dr. Asempa explains, it’s not always possible to get back the same head of hair you had when you were younger—but I think Black women should feel encouraged by the various emerging treatments that appear to be helping with hair growth, especially in conditions where hair loss was previously thought to be untreatable.
In many ways, having more dermatologists committed to seeing improved treatment outcomes for Black women, who haven’t always been prioritized in medical research, is the real game changer. “I think a lot of Black dermatologists tend to specialize in hair loss because hair loss is such an emotional problem for Black women,” Dr. Asempa says. Especially with these new treatment options, she feels confident in her practice’s stated approach: “There's nobody that walks in my door that I can't treat.”
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