Azelaic Acid for Central Centrifugal Cicatricial Alopecia

((CCCA) Trial)

Overseen by Amy McMichael, MD

Age: 18+

Sex: Female

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase < 1

Recruiting

Sponsor: Wake Forest University Health Sciences

Disqualifiers: Males

No Placebo Group

Approved in 2 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial is testing azelaic acid to see if it can help people with Central Centrifugal Cicatricial Alopecia (CCCA), a challenging hair loss condition. Azelaic acid might reduce inflammation, which could help hair grow back. The study aims to determine the effectiveness of azelaic acid. Azelaic acid has been used effectively for treating acne and rosacea, and it has shown potential in promoting hair growth when combined with minoxidil.

Will I have to stop taking my current medications?

The trial requires that participants have been on a stable treatment without changes for at least three months, so you should not stop taking your current medications if they have been stable.

What evidence supports the effectiveness of the drug azelaic acid for treating central centrifugal cicatricial alopecia?

Azelaic acid has been shown to be effective in treating acne and rosacea due to its anti-inflammatory and antibacterial properties, which may suggest potential benefits for other inflammatory skin conditions. ^{1 2 3 4 5}

How does the drug azelaic acid differ from other treatments for central centrifugal cicatricial alopecia?

Azelaic acid is unique because it has antimicrobial and anti-inflammatory properties, and it normalizes keratinization (the process of forming the outer layer of skin), which may help in conditions like central centrifugal cicatricial alopecia. Unlike some other treatments, it is less irritating and does not cause allergic reactions, making it suitable for long-term use. ^{1 2 6 7 8}

Research Team

Amy McMichael, MD

Principal Investigator

Wake Forest University Health Sciences

Eligibility Criteria

This trial is for women over 18 with a confirmed diagnosis of Central Centrifugal Cicatricial Alopecia (CCCA) stages II-IV. Participants must have been on a stable treatment plan for at least three months without changes, and they are recruited from outpatient dermatology clinics.

Inclusion Criteria

I am a woman aged 18 or older.

My current treatment has not changed for at least three months.

recruited from outpatient dermatology clinics at the Wake Forest Baptist Health Department of Dermatology

Exclusion Criteria

I am male.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive azelaic acid or placebo treatment applied topically on the scalp once daily

6 months

Visits at baseline, months 2, 4, and 6

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Azelaic Acid (Other)

Trial Overview The study tests azelaic acid's effectiveness against CCCA compared to a placebo. Azelaic acid is thought to reduce inflammation that can interfere with hair growth. This pilot study aims to see if it could be an effective treatment option.

Participant Groups

Group I: azelaic acid treatment Experimental Treatment 1 Intervention

Subjects will use the topical formulation once daily on the scalp. The subjects will use the treatment for a total of 6 months.

Group II: control (no additional treatment) Placebo Group 1 Intervention

Subjects will continue to use their current primary provider prescribed topical formulation once daily on the scalp. The subjects will use their treatment for a total of 6 months.

Who Is Running the Clinical Trial?

Wake Forest University Health Sciences

Lead Sponsor

Trials

1,432

Recruited

2,506,000+

Dr. L. Ebony Boulware

Wake Forest University Health Sciences

Chief Medical Officer since 2022

MD from Duke University School of Medicine, MPH from Johns Hopkins Bloomberg School of Public Health

Dr. Julie Ann Freischlag

Wake Forest University Health Sciences

Chief Executive Officer since 2020

BS from University of Illinois, MD from Rush University

Findings from Research

Azelaic acid 20% cream (AZELEX) is an effective anti-acne treatment, showing comparable efficacy to other common treatments like 0.05% tretinoin, 5% benzoyl peroxide, and 2% erythromycin.

One of the key advantages of azelaic acid is that it is less irritating than tretinoin and benzoyl peroxide, making it a gentler option for acne treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Azelaic acid 20% cream (AZELEX) and the medical management of acne vulgaris. Gibson, JR.[2016]

Azelaic acid cream (20%) is an effective topical treatment for mild to moderate acne, showing comparable efficacy to established therapies like tretinoin and benzoyl peroxide, based on vehicle-controlled studies.

It has a favorable safety profile, being non-teratogenic and well-tolerated, with no systemic side effects or resistance development in acne-causing bacteria, making it a suitable option for long-term maintenance therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy and safety of topical azelaic acid (20 percent cream): an overview of results from European clinical trials and experimental reports. Graupe, K., Cunliffe, WJ., Gollnick, HP., et al.[2014]

A combination of topical 20% azelaic acid cream and oral minocycline was found to be highly effective for treating severe inflammatory acne, achieving significant reductions in acne lesions, although it was slightly less effective than oral isotretinoin.

This combined treatment was better tolerated than isotretinoin, with fewer side effects, making it a safer alternative, especially for women of child-bearing potential, and it can also be used successfully as maintenance therapy to prevent acne recurrence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of combined azelaic acid cream plus oral minocycline with oral isotretinoin in severe acne. Gollnick, HP., Graupe, K., Zaumseil, RP.[2014]

Azelaic acid has multiple beneficial effects, including anti-infective and anti-inflammatory properties, making it useful for treating various skin conditions.

It effectively inhibits follicular keratinization and reduces melanin production in the skin, supporting its use in managing disorders like acne and hyperpigmentation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Azelaic Acid: Evidence-based Update on Mechanism of Action and Clinical Application. Schulte, BC., Wu, W., Rosen, T.[2015]

Azelaic acid 15% gel (Finacea) is a new and effective first-line treatment for mild-to-moderate papulopustular rosacea, showing significant improvement in inflammatory lesions and redness over 15 weeks.

The main action of azelaic acid is its anti-inflammatory effect, which reduces reactive oxygen species, and it has a favorable safety profile with mostly mild side effects that rarely require stopping treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Azelaic acid 15% gel in the treatment of rosacea. Gollnick, H., Layton, A.[2019]

Topical azelaic acid (20% cream) is an effective and non-toxic treatment for all types of acne, showing comparable efficacy to other common acne treatments like tretinoin and benzoyl peroxide, based on extensive multi-centre clinical trials.

Azelaic acid is safe for long-term use, as it does not cause irritation, allergic reactions, or teratogenic effects, making it suitable for maintenance therapy and individual lesion treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Azelaic acid in the treatment of acne]. Nazzaro-Porro, M., Passi, S., Picardo, M., et al.[2014]

A study involving ten teenagers with acne showed that topical application of 20% azelaic acid cream led to a significant reduction of about 26% in the number of comedos (blocked hair follicles) after four months of treatment.

The effectiveness of azelaic acid in reducing comedos may be linked to its ability to alter keratin production or exert anti-hormonal effects, supporting its use as a treatment for acne.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Evaluation of the anti-comedo effect of azelaic acid using the technique of horny layer biopsy and scanning electron microscopy]. Angius, AG., Barbareschi, M., Cattaneo, M., et al.[2014]

Azelaic acid is a naturally occurring compound that has shown significant potential as a therapeutic agent, particularly due to its ability to inhibit tyrosinase and other enzymes, as well as its antimicrobial effects against various microorganisms, including those causing acne.

Topical application of azelaic acid (20% cream) has demonstrated therapeutic benefits for different skin disorders, especially in treating various forms of acne and showing promise in managing conditions like melasma and cutaneous malignant melanoma, with minimal toxicity to normal cells.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Azelaic acid. Nazzaro-Porro, M.[2019]

References

1. United States pubmed.ncbi.nlm.nih.gov

Azelaic acid 20% cream (AZELEX) and the medical management of acne vulgaris. [2016]

2. United States pubmed.ncbi.nlm.nih.gov

Efficacy and safety of topical azelaic acid (20 percent cream): an overview of results from European clinical trials and experimental reports. [2014]

3. France pubmed.ncbi.nlm.nih.gov

Comparison of combined azelaic acid cream plus oral minocycline with oral isotretinoin in severe acne. [2014]

4. United States pubmed.ncbi.nlm.nih.gov

Azelaic Acid: Evidence-based Update on Mechanism of Action and Clinical Application. [2015]

5. England pubmed.ncbi.nlm.nih.gov

Azelaic acid 15% gel in the treatment of rosacea. [2019]

6. Italy pubmed.ncbi.nlm.nih.gov

[Azelaic acid in the treatment of acne]. [2014]

7. Italy pubmed.ncbi.nlm.nih.gov

[Evaluation of the anti-comedo effect of azelaic acid using the technique of horny layer biopsy and scanning electron microscopy]. [2014]

8. United States pubmed.ncbi.nlm.nih.gov

Azelaic acid. [2019]