Glycemic Control Influences Outcomes in Central Cicatricial Alopecia, with Crystal Aguh, MD

Data presented at the 2025 American Academy of Dermatology (AAD) Annual Meeting suggest improved glycemic control could help patients with central centrifugal cicatricial alopecia (CCCA) lessen the burden of their disease.

A retrospective cohort study led by a team from Johns Hopkins School of Medicine, results of the study demonstrate those maintaining an HbA1c level less than 5.7% were 5 times more likely to experience improvement in scalp fibrosis as their counterparts with an HBA1c in the diabetes or prediabetes range.

“I think as dermatologists, we are used to our specialty overlapping with other specialties such as rheumatology, infectious disease, but I think one specialty we need to take a closer look at is endocrinology,” explained lead investigator Crystal Aguh, MD, an associate professor of dermatology and the director of the Ethnic Skin Program at the Johns Hopkins School of Medicine, in an interview with HCPLive. “A lot of our skin diseases actually are impacted by insulin resistance and diabetes, and I'm hopeful that moving forward, this will be a bigger emphasis within our field.”

A retrospective cohort study of patients treated at Johns Hopkins Hospital between June 2022 and June 2024, the analysis aimed to better illustrate the relationship between elevated HbA1c levels and clinical symptoms of CCCA. During this time period, 81 patients received care and were deemed eligible for inclusion in the current study.

Participants were evaluated for scalp pruritus, pain, inflammation, and fibrosis. Elevated HbA1C was defined as 5.7% or greater, which is the recognized American Diabetes Association threshold for prediabetes. For the purpose of analysis, scalp fibrosis was assessed based on resistance during intralesional steroid treatment, ranging from none to significant resistance, occasionally causing needle bending or dulling.

In multivariable-adjusted analyses, controlling for age, diabetes medication, and BMI, results indicated elevated HbA1c was significantly associated with scalp fibrosis (Odds Ratio, 5.67; 95% CI, 1.40 to 22.95; P = .02), with no significant associations found for pruritus, pain, or inflammation.

To learn more about this study and the growing evidence base surrounding associations between glycemic control and dermatological conditions, check out our interview with Aguh during the Skin of Color Society’s Scientific Symposium.

Relevant disclosures for Aguh include Eli Lilly and Company, Myovant Sciences, and Pfizer.

Reference:

Chang S, Wyche J, Aguh C. Elevated Hemoglobin A1C Levels Associated with Increased Scalp Resistance in Central Centrifugal Cicatricial Alopecia. Presented at the 2025 American Academy of Dermatology (ADA) Annual Meeting. Orlando, FL. March 07-11, 2025.