Article

A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Topical minoxidil solution 2% stimulates new hair growth and helps stop the loss of hair in individuals with androgenetic alopecia (AGA). Results can be variable, and historical experience suggests that higher concentrations of topical minoxidil may enhance efficacy. The purpose of this 48-week, double-blind, placebo-controlled, randomized, multicenter trial was to compare 5% topical minoxidil with 2% topical minoxidil and placebo in the treatment of men with AGA. A total of 393 men (18-49 years old) with AGA applied 5% topical minoxidil solution (n = 157), 2% topical minoxidil solution (n = 158), or placebo (vehicle for 5% solution; n = 78) twice daily. Efficacy was evaluated by scalp target area hair counts and patient and investigator assessments of change in scalp coverage and benefit of treatment. After 48 weeks of therapy, 5% topical minoxidil was significantly superior to 2% topical minoxidil and placebo in terms of change from baseline in nonvellus hair count, patient rating of scalp coverage and treatment benefit, and investigator rating of scalp coverage. Hair count data indicate that response to treatment occurred earlier with 5% compared with 2% topical minoxidil. Additionally, data from a patient questionnaire on quality of life, global benefit, hair growth, and hair styling demonstrated that 5% topical minoxidil helped improve patients' psychosocial perceptions of hair loss. An increased occurrence of pruritus and local irritation was observed with 5% topical minoxidil compared with 2% topical minoxidil. In men with AGA, 5% topical minoxidil was clearly superior to 2% topical minoxidil and placebo in increasing hair regrowth, and the magnitude of its effect was marked (45% more hair regrowth than 2% topical minoxidil at week 48). Men who used 5% topical minoxidil also had an earlier response to treatment than those who used 2% topical minoxidil. Psychosocial perceptions of hair loss in men with AGA were also improved. Topical minoxidil (5% and 2%) was well tolerated by the men in this trial without evidence of systemic effects.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... MNX, the most widely administered drug initially developed for hypertension treatment, was discovered to promote hair density. MNX has been identified as a potassium channel opener; however, its exact hair growth mechanism is not fully understood [7]. ...
... In previous reports, the nonvellus hair density increased by 24.5 number/cm 2 from 151.1 (±45.9) number/cm 2 after 48-week (12 months) administration of 5% MNX [7]. On the contrary, in Ramos et al., 2019, 5% topical MNX promoted increased total hair density from 163.2 (±46.0) to 176.3 (±61.5) ...
... Baldness was evaluated by comparison with reference pictures according to the method described by dermatologists [60]. Hair density was measured using the phototrichogram technique with ×60 magnification [7,61]. Hair thickness was measured using image evaluation. ...
Article
Full-text available
Aging (senescence) is an unavoidable biological process that results in visible manifestations in all cutaneous tissues, including scalp skin and hair follicles. Previously, we evaluated the molecular function of adenosine in promoting alopecia treatment in vitro. To elucidate the differences in the molecular mechanisms between minoxidil (MNX) and adenosine, gene expression changes in dermal papilla cells were examined. The androgen receptor (AR) pathway was identified as a candidate target of adenosine for hair growth, and the anti-androgenic activity of adenosine was examined in vitro. In addition, ex vivo examination of human hair follicle organ cultures revealed that adenosine potently elongated the anagen stage. According to the severity of alopecia, the ratio of the two peaks (terminal hair area/vellus hair area) decreased continuously. We further investigated the adenosine hair growth promoting effect in vivo to examine the hair thickness growth effects of topical 5% MNX and the adenosine complex (0.75% adenosine, 1% penthenol, and 2% niacinamide; APN) in vivo. After 4 months of administration, both the MNX and APN group showed significant increases in hair density (MNX + 5.01% (p < 0.01), APN + 6.20% (p < 0.001)) and thickness (MNX + 5.14% (p < 0.001), APN + 10.32% (p < 0.001)). The inhibition of AR signaling via adenosine could have contributed to hair thickness growth. We suggest that the anti-androgenic effect of adenosine, along with the evaluation of hair thickness distribution, could help us to understand hair physiology and to investigate new approaches for drug development.
... Furthermore, it seems that many of these OTC hair loss brands do not adequately mention and explain the adverse effects of the product. Minoxidil is an effective vasodilator that has been demonstrated to increase hair growth and help reduce hair loss in people with androgenetic alopecia (AGA) [23]. However, topical minoxidil can result in minor scalp dryness and irritation, which can cause itching and discomfort [23]. ...
... Minoxidil is an effective vasodilator that has been demonstrated to increase hair growth and help reduce hair loss in people with androgenetic alopecia (AGA) [23]. However, topical minoxidil can result in minor scalp dryness and irritation, which can cause itching and discomfort [23]. Additionally, it may also develop adverse effects, such as allergic contact dermatitis, a skin irritation brought on by an allergy to minoxidil that manifests as scalp redness, itching, and occasionally blistering [23]. ...
... However, topical minoxidil can result in minor scalp dryness and irritation, which can cause itching and discomfort [23]. Additionally, it may also develop adverse effects, such as allergic contact dermatitis, a skin irritation brought on by an allergy to minoxidil that manifests as scalp redness, itching, and occasionally blistering [23]. ...
Article
Full-text available
Introduction The over-the-counter (OTC) market for hair loss products, particularly those containing minoxidil, has significantly expanded due to the increased prevalence of hair loss. Minoxidil, a vasodilator medication, is known for its potential to stimulate hair growth. However, the rise in OTC formulations has led to misleading advertising and marketing, with some companies exaggerating the benefits of their products while minimizing potential adverse effects. Methods A Google Boolean Search was conducted to identify OTC minoxidil products. The topmost non-sponsored search engine result page was used for analysis. Products not containing any dosage of minoxidil were excluded, resulting in nine products. These were individually searched on Amazon and eight were analyzed for any addressed safety information and adverse effects profile. Results The analysis revealed that only two out of eight products (25%) reported safety information, and none of the products (0%) reported any adverse effects. Significant observations were found surrounding the transparency and accuracy of the advertising and marketing of these products. Many companies made bold claims about their products without providing supporting scientific evidence or studies. Furthermore, many of these OTC hair loss brands did not adequately mention and explain the adverse effects of the product. Conclusions The study highlights the need for greater transparency in the marketing of OTC minoxidil products. Companies should provide clear and accessible information about the safety and potential adverse effects of their products. This will empower consumers to make informed decisions and foster trust between the industry and the consumer. Furthermore, the authenticity and accuracy of marketing images should be ensured to avoid giving false hopes to consumers.
... Despite the fact that the management of FPHL with topical minoxidil [7,8], dutasteride and finasteride [9][10][11][12][13], flutamide [14,15], cyproterone acetate [16], and oral and topical spironolactone [17] has widely been discussed in the literature, there is an increasing need and scope for a better, more effective, and more appropriate therapeutic approach for the management of FPHL in patients with comorbid PCOS due to the complexity, multiple pathomechanisms, widespread impact on patients, and negative impact on quality of life. Against this background, we examined the effectiveness of Dr. SKS Hair Booster Serum in treating FPHL in patients with PCOS. ...
... In literature, topical minoxidil [7,8], dutasteride and finasteride [3,[9][10][11][12], flutamide [13,14], cyproterone acetate [15], and oral and topical spironolactone [16] have been proved to be fruitful in treating FPHL associated PCOS. However, these treatments are associated with several side effects. ...
... However, these treatments are associated with several side effects. As such, Lucky et al. [7] and Olsen et al. [8] discovered that 5% topical minoxidil was more effective than 2% topical minoxidil for treating FPHL. However, these were associated with an increased occurrence of pruritus, local irritation, and hypertrichosis. ...
Article
Full-text available
Background Many patients with polycystic ovary syndrome (PCOS) exhibit female pattern hair loss (FPHL). A more advanced, efficient, and suitable therapeutic approach is required to effectively manage FPHL in patients with PCOS. Aim Dr. SKS Hair Booster Serum is composed of copper, niacinamide, hyaluronic acid, thiamine, riboflavin, and biotin; each of these constituents has demonstrated individual efficacy in promoting hair growth and enhancing hair quality. We hereby assess the effectiveness of this novel hair formulation in treating FPHL in PCOS. Methods This was an open-label, non-randomized, multicenter, prospective, large study with a wide range of age groups. The study involving 1,000 females aged 25-50 years, diagnosed with PCOS and having complaints of FPHL with Ludwig grades I and II. Each patient received a monthly session of Dr. SKS Hair Booster Serum, with 1 mL of serum administered through injection into the superficial layer (dermis) of the scalp using a tiny infusion via an insulin syringe, mesotherapy, or via a derma roller/derma pen. All the patients were subjected to standard global photography, video microscopic assessment (vellus hair counts, terminal hair counts, and hair shaft diameter), and a subject self-assessment questionnaire at baseline and six months after the treatment. Results After six months of the treatment, the hair shaft diameter, terminal hair counts, and hair growth rate were significantly increased than baseline (p≤0.0001), and a significant reduction was noted in vellus hair counts than baseline measurement (p<0.00001). These findings are suggestive of improved hair regrowth after the treatment. No adverse events were recorded during the study. Statistically significant improvements were observed in hair parameters (overall hair fall rate, hair texture, hair volume, and scalp itching) after six months of treatment than baseline. Conclusion Dr. SKS Hair Booster Serum has been shown to be an effective treatment for FPHL in patients with PCOS. This study marks the first investigation into the use of Dr. SKS Hair Booster Serum in patients with PCOS.
... Minoxidil is a potassium channel opener; however, the mechanism by which it treats alopecia remains unclear [10]. Side effects of minoxidil, such as pruritus, dermatitis, and irritation, have been reported [11]. ...
... The total investigation period was 12 weeks and terminal hair density was evaluated. Hair density was measured using the phototrichogram technique with ×60 magnification [10,34]. All measurements were performed by the same investigator, who was blinded. ...
Article
Full-text available
Platycladus orientalis is a traditional oriental herbal medicinal plant that is widely used as a component of complex prescriptions for alopecia treatment in Eastern Asia. The effect of PO on hair growth and its underlying mechanism, however, have not been demonstrated or clarified. In this study, we investigated the hair-growth-promoting effect of PO in cultured human dermal papilla cells (hDPCs). Platycladus orientalis leaf extract (POLE) was found to stimulate the proliferation of hDPCs. POLE with higher quercitrin concentration, especially, showed a high level of cellular viability. In the context of cellular senescence, POLE decreased the expression of p16 (CDKN2A) and p21(CDKN1A), which resulted in enhanced proliferation. In addition, growth factor receptors, FGFR1 and VEGFR2/3, and non-receptor tyrosine kinases, ACK1 and HCK, were significantly activated. In addition, LEF1, a transcription factor of Wnt/β-catenin signaling, was enhanced, but DKK1, an inhibitor of Wnt/β-catenin signaling, was downregulated by POLE treatment in cultured hDPCs. As a consequence, the expression of growth factors such as bFGF, KGF, and VEGF were also increased by POLE. We further investigated the hair-growth-promoting effect of topically administered POLE over a 12-week period. Our data suggest that POLE could support terminal hair growth by stimulating proliferation of DPCs and that enhanced production of growth factors, especially KGF, occurred as a result of tyrosine kinase ACK1 activation.
... 15 In yet another study comparing the efficacy of 5% and 2 % of minoxidil, it was found that the effects of minoxidil were observed earlier in patients on minoxidil 5% and that 45% better hair growth was noted in this group relative to the 2% group. 16,17 Ethanol enhances the poor water solubility of topical minoxidil; however, it causes severe adverse reactions such as scalp dryness, scaling, irritation, burning, pruritus, redness, and allergic contact dermatitis. 18,19 In addition, ethanol-based formulations tend to leave behind insoluble crystalline minoxidil on the scalp or skin as ethanol evaporates. ...
... Our results are consistent with the findings from other studies evaluating minoxidil treatment for AGA. 17,[27][28][29] We observed improvements in the ATR indicating increased hair follicles in the anagen (growth) phase, decreased shedding of a hair, and improved volume and appearance post-treatment with minoxidil 5%. By day 180, ATR increased by 0.4. ...
Article
Full-text available
Background: Androgenetic alopecia (AGA) is a common dermatological condition in India, with potentially adverse psychosocial consequences. Here, we assess the effectiveness and safety of an alcohol-free, procapil-based formulation of minoxidil 5% in patients with AGA. Methods: Treatment-naïve, male patients (aged 18 to ≤45 years) with AGA were enrolled in this open-label, single-arm, non-comparative, investigator-initiated study. The change in anagen/telogen ratio (ATR), hair density, and hair shaft thickness from baseline to days 45, 90, 135 and 180, investigator and patients’ global assessment for effectiveness and tolerability, and safety were assessed. A total of 53 men were enrolled. Results: The mean (standard deviation [SD]) age of the study population was 28.3 (6.0) years. The mean (SD) ATR improvement post-treatment with minoxidil 5% was seen from day 90 (mean change: 0.4; p=0.009; 95% confidence interval [CI]: 0.1-0.7) till Day 180 (mean change: 0.4; p=0.011; 95% CI: 0.1-0.6). Improvement in hair density (p<0.01) and hair shaft thickness (p<0.01) across frontal, temporal, and occipital regions was also evident. The investigator assessment for effectiveness was ‘excellent’/’good’/’satisfactory’ for 90% of patients, which corroborated with patients’ assessment (90%) at day 180. All the investigators and patients indicated that minoxidil had ‘good’ tolerability for all patients. No adverse events were reported during the study. Conclusions: Alcohol-free minoxidil 5% was found to have a good safety profile and was efficacious in Indian male patients with AGA, with a high level of patient acceptance.
... comparing efficacy of 5-2% topical minoxidil, patients experienced 45% greater hair regrowth in the group using 5% minoxidil at week 48. In addition, men using 5% topical minoxidil had increased nonvellus hair count at the first evaluation time point (8 weeks) indicating an earlier response to treatment than the control group (p = 0.021) [3]. Similarly, in a 48-week, double-blind, placebo-controlled, randomized, multicenter trial of 381 women ages 18-49 years, comparing 5-2% topical minoxidil, the 5% solution was superior in primary efficacy end points: promoting hair growth as measured by change in nonvellus hair count and patient/investigator assessments of hair growth and scalp coverage (p < 0.05) [4]. ...
... Similarly, in a 48-week, double-blind, placebo-controlled, randomized, multicenter trial of 381 women ages 18-49 years, comparing 5-2% topical minoxidil, the 5% solution was superior in primary efficacy end points: promoting hair growth as measured by change in nonvellus hair count and patient/investigator assessments of hair growth and scalp coverage (p < 0.05) [4]. Both studies found that both 2% and 5% topical minoxidil improved psychosocial perceptions of hair loss [3,4]. ...
Article
Full-text available
b> Introduction: Androgenetic alopecia (AGA) is the most common form of hair loss, with negative impact on patient quality of life. Oral minoxidil is used off-label for AGA treatment. We hypothesized increased public interest in oral minoxidil for hair loss treatment following the New York Times (NYT) Article on oral minoxidil: “An Old Medicine Grows New Hair for Pennies a Day, Doctors Say.” The objective of this study was to quantify interest in oral minoxidil for hair loss treatment before and after the NYT article and help inform dermatologists about treatments of interest to their patients. Method: We performed a cross-sectional analysis of Google Trends evaluating relative prevalence of “oral minoxidil,” “minoxidil,” “hair loss,” and “Rogaine<sup>®</sup>” 2/2022–5/2023. t tests compared mean search volume and linear regression analysis quantified changes in public interest over time. Results: Oral minoxidil and minoxidil search volumes increased from 0.86 to 3.00 and 22.43 to 32.60, respectively, before and after the NYT article (both p < 0.05). Minoxidil searches continually increased by 500,000 searches per month ( p < 0.001). Conclusions: There was a significant and sustained increase in Google searches for oral minoxidil after publication of the NYT article, indicating increased patient interest. Larger clinical trials are needed to provide evidence-based care to AGA patients.
... Many previous studies have investigated the efficacy and safety of 5% minoxidil in the treatment of AGA [4,[17][18][19] and found varied hair growth in 54-62% of patients [17]. However, compared to traditional minoxidil, the unique cetosomal minoxidil seems to have a few advantages, including the absence of propylene glycol (implicit inconvenience) and a quicker time to dry after application. ...
... Many previous studies have investigated the efficacy and safety of 5% minoxidil in the treatment of AGA [4,[17][18][19] and found varied hair growth in 54-62% of patients [17]. However, compared to traditional minoxidil, the unique cetosomal minoxidil seems to have a few advantages, including the absence of propylene glycol (implicit inconvenience) and a quicker time to dry after application. ...
Article
Full-text available
Introduction Patients with androgenetic alopecia (AGA), who use alcohol-based topical minoxidil solutions, frequently experience localized irritation, dryness, and scalp redness. In this study, we compared the safety and effectiveness of topical 5% cetosomal minoxidil solution to those of topical 5% alcohol-based minoxidil solution in Indian men with AGA. Methods In this randomized, open-label study, male patients with AGA were randomized 1:1 to receive either solutions twice daily for 16 weeks. Efficacy endpoints included changes in basic and specific (BASP) grading, improvement in the trichoscopy score, and global photography at week 16 from baseline, whereas safety was evaluated by adverse events reported by patients and hair-related quality of life (QoL) using the Hairdex-29 questionnaire. Results Of the 80 patients, only 40 completed the study and were considered for complete analysis. Twelve out of 23 patients (52%) in the cetosomal minoxidil group and four out of 17 patients (24%) in the alcohol-based minoxidil group showed a positive increase in hair growth according to the trichoscopy score (p=0.1). According to the BASP grading system, nine patients (39%) and five patients (29%) in the cetosomal and alcohol-based minoxidil groups, respectively, showed improvement (p=0.73). Similarly, 19 (83%) and 10 (59%) patients in the cetosomal and alcohol-based minoxidil groups, respectively, reported positive hair growth on the global photography assessment (p=0.15). All the patients tolerated the treatment well, with no discontinuation in either group. There were four adverse events in the cetosomal minoxidil group, reported by two (9%) patients, whereas in the alcohol-based minoxidil group, 10 adverse events were reported by seven (41%) patients (p=0.02). In addition, the mean Hairdex-29 score of 40.26±4.71 at baseline improved to 32.32±3.35 in the cetosomal group, whereas it improved to 34.64±3.41 from 39.64±4.98 in the other group (p=0.03). Conclusions The 5% cetosomal minoxidil group showed improved safety but similar efficacy when administered twice daily. Therefore, cetosomal minoxidil may be a better option for treating AGA in males who are sensitive or nontolerant to alcoholic formulations.
... Androgenic alopecia and alopecia areata are the two subtypes of alopecia that may be classified as "further alopecia". 90,91 Minoxidil is a drug that has undergone a significant amount of study and has been given approval for use in the treatment of alopecia. 91 Although minoxidil is the drug of choice, its therapeutic effectiveness in many typical delivery techniques at the pharmacokinetic platform is poor. ...
... 90,91 Minoxidil is a drug that has undergone a significant amount of study and has been given approval for use in the treatment of alopecia. 91 Although minoxidil is the drug of choice, its therapeutic effectiveness in many typical delivery techniques at the pharmacokinetic platform is poor. 92 This is despite the fact that minoxidil is the medication of choice. ...
... Efficacy: Research on Low-Level Laser Therapy has revealed a moderate degree of efficacy, with a reported 17-30% increase in hair density in just 24 weeks. 15 1. Some research has suggested that GFC used with a Derma Roller may be more effective. ...
Article
Full-text available
Androgenetic alopecia (AGA) is a common cause of hair loss in both men and women. Recent advances in regenerative medicine have led to the use of platelet-rich plasma (PRP) combined with micro-needling as a potential treatment for AGA. However, the clinical effectiveness of this combination therapy remains unclear. To evaluate the efficacy and safety of platelet-rich plasma (PRP) combined with micro-needling for the treatment of androgenetic alopecia through a systematic review and meta-analysis of available clinical studies. A systematic search was conducted in PubMed, Embase, and the Cochrane Library for studies published up to January 2024. Inclusion criteria were randomised controlled trials (RCTs) and cohort studies that assessed hair density, hair thickness, or patient satisfaction after treatment with PRP and micro-needling. Data were extracted and pooled using a random-effects model, and heterogeneity was assessed with the I² statistic. The quality of the studies was evaluated using the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for cohort studies. A total of 12 studies involving 546 participants were included. Meta-analysis showed that the combination of PRP and micro-needling significantly increased hair density (mean difference: 18.9 hairs/cm², 95% CI: 15.3-22.5, p < 0.001) and hair thickness (mean difference: 0.4 mm, 95% CI: 0.3-0.5, p < 0.01) compared to controls. Patient satisfaction was also higher in the treatment group. The most commonly reported adverse effects were mild scalp irritation and transient erythema, with no serious adverse events. Moderate heterogeneity was observed among the studies (I² = 42%). The combination of PRP and micro-needling is an effective and well-tolerated treatment for androgenetic alopecia, resulting in significant improvements in hair density and thickness. Further large-scale, high-quality trials are needed to confirm these findings and standardize treatment protocols.
... The calculation of the sample size (by Epidat 3.1 software) was based on the primary variable, which was the increase in the number of hairs per square centimeter during the 16-week follow-up period. To achieve a precision of 12 hairs/cm 2 , an alpha risk of 5%, and a power of 80%, 55 subjects were required in each group considering a standard deviation of 25.4 hairs/cm 2 [24]. To account for a 15% dropout rate, 65 participants were required in each group. ...
Article
Full-text available
This study aimed to assess the impact of a combination of probiotic strains of Lactiplantibacillus on the treatment of androgenic alopecia (AGA). To this end, 136 individuals with AGA (62 men and 74 women) aged 18–65 years were enrolled in a double-blind, parallel-group clinical trial. A total of 115 individuals (57 in the probiotic group and 58 in the placebo group) completed this study within a 16-week intervention period. Capillary density, thickness, and length of hair were analyzed before and after the intervention using FotoFinder Trichoscale Pro. In addition, the gut microbiota was assessed by paired-end sequencing on the Illumina MiSeq platform (2 × 300 bp). At the conclusion of the treatment period, a notable decline (p < 0.05) in the number of telogen hairs was evident in the probiotic group while hair thickness decreased in the placebo group (p < 0.05). However, the remaining variables did not exhibit any statistically significant changes. In the probiotic-treated group, individuals aged less than 37.5 years exhibited a reduction in the number and density of telogen hair (p = 0.0693 and p = 0.0669, respectively) and an increase in hair length (p = 0.0871). Furthermore, a notable decline in the number and density of vellus hair (p < 0.05) was observed, and this was accompanied by no change in the hair thickness. The probiotic-treated group exhibited a significantly higher abundance of Lactobacillus (p-adjusted < 0.05, DEseq2 test) and demonstrated a notable reduction in the number and density of telogen hair, and this was accompanied by an increase in the percentage of anagen hair. The probiotic mixture was well tolerated by the participants, with a treatment adherence rate of 90%. In light of this study’s limitations, it can be concluded that a mixture of three strains of Lactiplantibacillus promotes the presence of terminal follicles, preventing their gradual miniaturization, which is a characteristic of AGA.
... An earlier response to treatment was also noted, with a non-vellus hair count at 8 weeks equivalent to that of a 16-week treatment with 2% minoxidil. Both concentrations were well tolerated with no evidence of systemic effects [17]. Side effects with topical minoxidil use include irritant and allergic contact dermatitis, scalp irritation, pruritus and facial hypertrichosis, which present more often with higher per cent formulations [18]. ...
Article
Androgenetic alopecia (AGA) presents a significant challenge in clinical practice due to its prevalence and impact on patients’ quality of life. With a diverse array of available treatment options, selecting the most appropriate therapy demands careful consideration of factors such as efficacy, safety, practicality, and cost. This review aims to evaluate the efficacy and safety profiles of various topical treatments for AGA, investigating their potential advantages in limiting systemic side effects compared to oral medications. This article explores the pharmacology, mechanisms of action, clinical efficacy, and adverse events associated with topical medications like minoxidil, finasteride, ketoconazole shampoo, clascoterone, latanoprost, spironolactone, flutamide, cetirizine, pyrilutamide, and GT20029.
... The findings revealed that treatment with 1 mg of finasteride for 6 and 12 months resulted in 7.3% and 8.99% increases in the total hair count, respectively [152]. Treatment with 2% and 5% minoxidil for 48 weeks increased the total hair count by 8.84% and 12.3%, respectively [153]. After 26-week-long LLLT with 9-and 12-beam laser combs, the total hair count increased by 12.79% and 16.96%, respectively [80]. ...
Article
Full-text available
Hair loss, or alopecia, is a prevalent condition in modern society that imposes substantial mental and psychological burden on individuals. The types of hair loss, include androgenetic alopecia, alopecia areata, and telogen effluvium; of them, androgenetic alopecia is the most common condition. Traditional treatment modalities mainly involve medical options, such as minoxidil, finasteride and surgical interventions, such as hair transplantation. However, these treatments still have many limitations. Therefore, exploring the pathogenesis of hair loss, specifically focusing on the development and regeneration of hair follicles (HFs), and developing new strategies for promoting hair regrowth are essential. Some emerging therapies for hair loss have gained prominence; these therapies include low-level laser therapy, micro needling, fractional radio frequency, platelet-rich plasma, and stem cell therapy. The aforementioned therapeutic strategies appear promising for hair loss management. In this review, we investigated the mechanisms underlying HF development and regeneration. For this, we studied the structure, development, cycle, and cellular function of HFs. In addition, we analyzed the symptoms, types, and causes of hair loss as well as its current conventional treatments. Our study provides an overview of the most effective regenerative medicine-based therapies for hair loss.
... Nevertheless, minoxidil has side effects affecting a certain percentage of users. Previous studies suggest minoxidil produces side effects in 13.7% of users in the high dose (5%) group and 10.3% of users in the low dose (2%) group, including itching, burning, and flaking (12). ...
Article
There is a great need for studying mechanisms of hair follicle cycles and designing small molecular drugs, biologics, formulation, and surgical treatment for androgenic alopecia (AGA, a common form of hair recession). While minoxidil has served as a solution in the past, it is a vasodilator and can react heavily with alcohol. Furthermore, minoxidil must be used at night, as it requires 6 hours for the product to settle and perform its function. Therefore, alternative approaches are needed to treat AGA. Numerous clinical trials are studying the use of fibroblast growth factors (FGFs) for tissue regeneration applications. Additionally, FGFs have been proven to stimulate stem cell growth and tissue regeneration. In the present study, we tested the effects of four FGFs, namely FGF1 (aFGF), FGF2 (bFGF), FGF10 (KGF-2), and FGF21, as compared to the gold standard, minoxidil, on isolated primary mouse hair follicle dermal papilla (DP) cells. We also used plain cell culture media (without growth factors or serum) as a negative control. Cell proliferation and viability were measured using both a biochemical assay and fluorescent microscope examinations. Our results indicate that several FGFs can promote DP cell proliferation. Interestingly, our results show that minoxidil promotes DP cell proliferation in the absence of a vascular system. In addition, DP cells cultured in FGFs exhibited a more organized cytoskeleton as compared to the ones cultured with minoxidil, suggesting the potential advantages of FGFs in general cellular health. In that regard, we hypothesize that FGFs can stimulate hair growth and treat AGA.
... This improvement is comparable with the results of studies on the efficacy of conventional treatment in AGA. In the previous study of 157 patients with male pattern of hair loss, 5% minoxidil application for 48 weeks increased the hair density by 12.3% which is comparable with this study [53]. In another study on the use of finasteride in 779 patients with male pattern hair loss, it was found to increase the hair density by 11.0% after 52 months of treatment [54]. ...
... 4,44 Interestingly, minoxidil was proposed to prolong the anagen phase via the induction of β-catenin activity, a key component of the Wnt pathway, and is known to be beneficial in MPHL. 45,46 In conclusion, this study underlines the involvement of WNT10A in both rare and common hair disorders, and describes a WNT10A -related hair phenotype that can be confirmed by molecular diagnostic screening of WNT10A in individuals with complaints suggestive of SAH, either as an isolated phenotype or in the presence of other ectodermal anomalies. ...
Article
Background: Short anagen hair (SAH) is a rare, paediatric hair disorder characterised by a short anagen phase, an inability to grow long scalp hair, and a negative psychological impact. The genetic basis of SAH is currently unknown. Objectives: Here, molecular genetic investigations were performed in 48 individuals with a clinical phenotype suggestive of SAH to identify, if any, the genetic basis of this condition. Methods: Exome sequencing was performed in 27 patients diagnosed with SAH or with complaint of short, non-growing hair. The cohort was screened for variants with a minor allele frequency (MAF) < 5% in the general population and a Combined Annotation Dependent Depletion (CADD) score > 15, to identify genes whose variants were enriched in this cohort. Sanger sequencing was used for variant validation and screening of 21 additional individuals with the same clinical diagnosis and their relatives. Genetic association testing of SAH-related variants for male pattern hair loss (MPHL) was performed using the UK Biobank data. Results: The analyses revealed that 20 individuals (∼40%) carried mono- or biallelic pathogenic variants in WNT10A. Rare WNT10A variants are associated with a phenotypic spectrum ranging from no clinical signs to severe ectodermal dysplasia (ED). A significant association was found between WNT10A and SAH, and this was mostly observed in individuals with light-coloured hair and a regression of the fronto-parietal hairline. Notably, the most frequent variant in the cohort, c.682T > A; p.(Phe228Ile), was in linkage disequilibrium with four common WNT10A variants, all of which have a known association with MPHL. Using UK Biobank data, our analyses showed that c.682T > A; p.(Phe228Ile), and one other variant identified in the SAH cohort, are also associated with MPHL, and partially explain the known associations between WNT10A and MPHL. Conclusions: Our results suggest that WNT10A is associated with SAH, and that SAH has a genetic overlap with the common phenotype MPHL. The presumed shared biological effect of WNT10A variants in SAH and MPHL is a shortening of the anagen phase. Other factors, such as modifier genes and sex, may also play a role in the clinical manifestation of hair phenotypes associated with the WNT10A locus.
... Only two minoxidil solutions-2% and 5%-have FDA approval for the treatment of AGA [28]. Olsen et al. [29] demonstrating that minoxidil 5% was more effective in improving hair count in men with AGA, however, it was associated with higher incidents of adverse events, compared to the lower concentration of minoxidil 2%. An evaluation of 5% and 10% topical minoxidil by Ghonemy et al. [30] showed increased efficacy with 5% topical minoxidil, with fewer adverse events. ...
Article
Full-text available
Androgenetic alopecia is a widespread condition that is the most common type of hair loss affecting approximately 58% and 40% of men and women by the age of 50, respectively. Patients have been known to experience severe distress due to androgenetic alopecia, including anxiety, low self-esteem, and depression. The objective of this study was to conduct a systematic review and meta-analysis to determine the efficacy of combination therapy using topical minoxidil and microneedling compared to topical minoxidil alone. This systematic review of randomized controlled trials was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The literature search was performed using Scopus, Cochrane, Embase, and the National Institutes of Health’s United States National Library of Medicine from inception through January 20, 2023. Randomized controlled trials examining the efficacy of combinational therapy and monotherapy using microneedling and minoxidil on patients with clinically diagnosed androgenetic alopecia were included after screening titles, abstracts, and full texts. Two independent reviewers selected studies, extracted data, and appraised the risk of bias using the Cochrane risk of bias assessment tool. Ten randomized controlled trials, including 466 patients, were selected for this review and eight studies were ultimately included in the meta-analysis. All eight studies displayed a statistically significant increase in total hair count [standard mean difference (SMD) 1.76; 95% CI 1.26–2.26; P < 0.00001]; however, the evidence did not support a statistically significant increase in hair diameter (SMD 0.82; 95% CI − 0.01 to 1.65; P = 0.05). No scarring nor serious adverse events were reported in any of the studies. The findings of this meta-analysis strongly support the utilization of a multimodal therapeutic approach of minoxidil and microneedling for hair growth in patients with androgenetic alopecia. However, variations in factors such as rating scale measurements, microneedling methods, and areas of treatment may have resulted in confounding. Further randomized controlled, large-sample trials employing rigorous methodologies are needed to gain a more comprehensive understanding regarding treatment efficacy, namely the impact of combinational therapy on hair diameter. Clinical trial registrations This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and is registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42023391164) and the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) database (INPLASY202310031).
... However, long-term usage of Finasteride is associated with rare complications like decreased libido, gynecomastia and psychologic impairments [11]. Minoxidil, on the other hand, induce vasodilation of peripheral vessels and improve microcirculation, leading to DPCs proliferation [12]. Nevertheless, topically applied Minoxidil is also absorbed into the systemic circulation and caused cardiovascular side effects [13]. ...
Article
Full-text available
Background Androgenetic alopecia (AGA) is one of the most common hair loss diseases worldwide. However, current treatments including medicine, surgery, and stem cells are limited for various reasons. Cell-free fat extract (CEFFE), contains various cell factors, may have potential abilities in treating AGA. This study aims to evaluate the safety, effectiveness and the underlying mechanism of CEFFE in treating AGA. Methods Sex hormone evaluation, immunogenicity assay and genotoxicity assay were conducted for CEFFE. In vivo study, male C57BL/6 mice were injected subcutaneously with dihydrotestosterone (DHT) and were treated with different concentration of CEFFE for 18 days (five groups and n = 12 in each group: Control, Model, CEFFE Low , CEFFE Middle , CEFFE High ). Anagen entry rate and hair coverage percentage were analyzed through continuously taken gross photographs. The angiogenesis and proliferation of hair follicle cells were evaluated by hematoxylin–eosin, anti-CD31, and anti-Ki67 staining. In vitro study, dermal papilla cells (DPCs) were incubated with different concentrations of CEFFE, DHT, or CEFFE + DHT, followed by CCK-8 assay and flow cytometry to evaluate cell proliferation cycle and apoptosis. The intracellular DHT level were assessed by enzyme-linked immunosorbent assay. The expression of 5α-reductase type II, 3α-hydroxysteroid dehydrogenase and androgen receptor were assessed through reverse transcription-quantitative polymerase chain reaction (RT-qPCR) or/and western blot. Results In CEFFE-treated mice, an increase in the anagen entry rate and hair coverage percentage was observed. The number of CD31-positive capillaries and Ki67-positive cells were increased, suggesting that CEFFE promoted the proliferation of DPCs, modulated the cell cycle arrest, inhibited apoptosis caused by DHT, reduced the intracellular concentration of DHT in DPCs, and downregulated the expression of AR. Conclusions CEFFE is a novel and effective treatment option for AGA through producing an increased hair follicle density and hair growth rate. The proposed mechanisms are through the DHT/AR pathway regulation and regional angiogenesis ability.
... In our study, > 60% of patients reported excellent product tolerability and cosmetic acceptability. Also, regarding safety, multiple studies on conventional minoxidil have reported AEs, like pruritus (1% to 9%), headache (2% to 4%), and dryness/scaling (2.8%) [11][12][13][14][15][16]. However, in our study, only 0.3% (1/261) of treatment-related AEs were observed. ...
Article
Introduction Topical minoxidil 5% is a widely used medication in the treatment of androgenetic alopecia (AGA) but is usually associated with adverse events (AE) such as scalp irritation, dryness, and itching. This prompted the development of nonalcoholic solutions, and cetosomal minoxidil was the most recent one. Methods Retrospective multicenter data analysis was conducted at 66 centers across India for adult AGA patients. Patients treated with either cetosomal minoxidil 5% alone (Group I) or a fixed drug combination of cetosomal minoxidil 5% and finasteride 0.1% (Group II) were analyzed for the effectiveness and safety of either formulation. The Physician Global Assessment (PGA) and Patient Global Assessment (PtGA) were used to assess each treatment's effectiveness. Safety was reported by records of AE and a product tolerability assessment with subjective cosmetic acceptability as recorded by physicians. Results Of the 261 patients, 132 were in Group I, and 129 were in Group II. At 16 weeks, in PGA, mild to moderate improvement was noted in 48% and 32% of patients in Groups I and II, respectively, whereas significant to excellent improvement was seen in 52% and 68% of patients in Groups I and II, respectively. Similar results were noted for PtGA. In Group I, 64% of patients rated the product's tolerability as excellent, and 69% reported the same in Group II. Meanwhile, 64% of patients in Group I and 74% in Group II rated the product as excellent in subjective cosmetic acceptability. Conclusions From real-world analysis, cetosomal-based minoxidil solutions were found to be effective and tolerable in AGA and could serve as therapeutic alternatives to alcoholic formulations for AGA management.
Article
Introduction: Alopecia Areata (AA), characterized by non-scarring hair loss due to the dysregulation of the JAK/STAT pathway, has long lacked effective treatment. In 2023, Ritlecitinib, a novel Janus kinase (JAK) 3 and tyrosine kinase family inhibitor, received its first approval from the US FDA to treat AA, followed by approvals in Japan, Europe, China, and the UK. This development aims to address the challenges faced by millions of individuals affected by this condition globally. Areas covered: This review offers an overview of Ritlecitinib's pharmacological properties, biological targets, and development strategies. It examines its mechanism of action, pharmacokinetics, pharmacodynamics, and clinical trial insights. Additionally, it covers the drug's chemical synthesis, contraindications, drug interactions, and potential adverse effects, with special attention to its use in adolescents, pregnant women, and the elderly. Expert opinion: Ritlecitinib represents a significant advancement in treating AA, offering a targeted approach with promising efficacy and a favorable safety profile. While long-term safety data and real-world effectiveness studies are needed, its oral administration and efficacy in both adults and adolescents position it as a potentially transformative therapy. Ongoing research should focus on optimizing treatment strategies, identifying predictive biomarkers, and assessing cost-effectiveness to fully realize Ritlecitinib's potential in improving outcomes.
Article
Full-text available
Androgenetic alopecia (AGA), the most common cause of hair loss, is influenced by various risk factors. Metabolic syndrome constitutes a collection of risk factors elevating the risk of cardiovascular disease. The presence of early-onset AGA could serve as an indicator of the emergence of metabolic syndrome, yet to date, no research has examined these parameters in AGA. This is a cross-sectional study comparing two groups; early onset versus normal onset AGA. Forty participants were enlisted and evenly distributed into the two groups. Subsequently, participants underwent examinations utilizing trichoscopy, trichoscan, and laboratory assessments. Apart from waist circumference, BMI, and age of alopecia onset, there were no notable differences concerning sociodemographic and clinical features. In terms of hair growth parameters, the telogen hair rate stands out as the sole indicator exhibiting a significant difference between both groups, while trichoscopy data also revealed varying hair characteristics. Lastly, metabolic parameters namely triglyceride, fasting blood glucose, HbA1c and HDL differ significantly, with the normal onset group demonstrating a higher prevalence of metabolic abnormality. This suggests a potential association between AGA and metabolic syndrome. However, the exact nature of this relationship remains uncertain, necessitating further research with larger samples, specific age groups and diverse study designs.
Article
b> Introduction: Cutis verticis gyrata (CVG) is a medical condition that is characterized by thickening of the scalp giving the scalp a cerebriform appearance. Due to an apparent paucity of the condition, limited research exists, and causes are as yet undetermined. What is known, is that the condition may either be a feature of several syndromes or occur as a consequence of a number of diseases or drugs that produce changes in scalp structure, particularly acromegaly, and theoretically, the use of growth hormone (GH) itself or the use of drugs that mimic the effect of GH (secretagogues). Case Presentation: We present a case of CVG that resulted from long-term topical use of minoxidil at a high concentration. Discussion and Conclusion: Minoxidil has been shown to be able to potentiate the mitogenic effects of insulin-like growth factor (IGF-1). Meanwhile, the striking manifestations of acromegaly are due to excessive IGF-1 production by the liver in response to GH stimulation. The growth-promoting properties of IGF-1 trigger soft tissue hypertrophy, and hypertrichosis. Pseudoacromegaly has been reported to be induced by the long-term use of oral minoxidil. This is the first case report of secondary CVG from the use of topical minoxidil for the treatment of male androgenetic alopecia.
Article
Full-text available
Background and purpose Hair loss is a prevalent problem affecting millions of people worldwide, necessitating innovative and efficient regrowth approaches. Nanostructured lipid carriers (NLCs) have become a hopeful option for transporting bioactive substances to hair follicles because of their compatibility with the body and capability to improve drug absorption. Review approach Recently, surface modification techniques have been used to enhance hair regeneration by improving the customization of NLCs. These techniques involve applying polymers, incorporating targeting molecules, and modifying the surface charge. Key results The conversation focuses on how these techniques enhance stability, compatibility with the body, and precise delivery to hair follicles within NLCs. Moreover, it explains how surface-modified NLCs can improve the bioavailability of hair growth-promoting agents like minoxidil and finasteride. Furthermore, information on how surface-modified NLCs interact with hair follicles is given, uncovering their possible uses in treating hair loss conditions. Conclusion This review discusses the potential of altering the surface of NLCs to customize them for enhanced hair growth. It offers important information for upcoming studies on hair growth.
Article
As the uncontrolled entry of calcium ions (Ca 2+) through plasmalemmal calcium channels is a cell death trigger, the conjecture is here raised that mitigating such an excess of Ca 2+ entry should rescue from death the vulnerable neurons in neurodegenerative diseases (NDDs). However, this supposition has failed in some clinical trials (CTs). Thus, a recent CT tested whether isradipine, a blocker of the Cav1 subtype of voltage-operated calcium channels (VOCCs), exerted a benefit in patients with Parkinson's disease (PD); however, outcomes were negative. This is one more of the hundreds of CTs done under the principle of one-drug-one-target, that have failed in Alzheimer's disease (AD) and other NDDs during the last three decades. As there are myriad calcium channels to let Ca 2+ ions gain the cell cytosol, it seems reasonable to predict that blockade of Ca 2+ entry through a single channel may not be capable of preventing the Ca 2+ flood of cells by the uncontrolled Ca 2+ entry. Furthermore, as Ca 2+ signaling is involved in the regulation of myriad functions in different cell types, it seems also reasonable to guess that a therapy should be more efficient by targeting different cells with various drugs. Here, we propose to mitigate Ca 2+ entry by the simultaneous partial blockade of three quite different subtypes of plasmalemmal calcium channels that is, the Cav1 subtype of VOCCs, the Orai1 store-operated calcium channel (SOCC), and the puri-nergic P2X7 calcium channel. All three channels are expressed in both microglia and neurons. Thus, by targeting the three channels with a combination of three drug blockers we expect favorable changes in some of the pathogenic features of NDDs, namely (i) to mitigate Ca 2+ entry into microglia; (ii) to decrease the Ca 2+-dependent microglia activation; (iii) to decrease the sustained neuroinflammation; (iv) to decrease the uncontrolled Ca 2+ entry into neurons; (v) to rescue vulnerable neurons from death; and (vi) to delay disease progression. In this review we discuss the arguments underlying our triad hypothesis in the sense that the combination of three repositioned medicines targeting Cav1, Orai1, and P2X7 calcium channels could boost neuroprotection and delay the progression of AD and other NDDs. Abbreviations Aβ amyloid-beta AChE acetylcholinesterase AD Alzheimer´s disease ALS amyotrophic lateral sclerosis AMPA α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor ARNI angiotensin receptor-neprilysin inhibitor ASO Antisense oligonucleotide (continued on next column)
Preprint
Full-text available
Androgenetic alopecia (AGA), the most common cause of hair loss, is influenced by various risk factors. Metabolic syndrome constitutes a collection of risk factors elevating the risk of cardiovascular disease. The presence of early-onset AGA could serve as an indicator of the emergence of metabolic syndrome, yet to date, no research has examined these parameters in AGA. This is a cross-sectional study comparing two groups; early onset versus normal onset AGA. Forty participants were enlisted and evenly distributed into the two groups. Subsequently, participants underwent examinations utilizing trichoscopy, trichoscan, and laboratory assessments. Apart from waist circumference, BMI, and age of alopecia onset, there were no notable differences concerning sociodemographic and clinical features. In terms of hair growth parameters, the telogen hair rate stands out as the sole indicator exhibiting a significant difference between both groups, while trichoscopy data also revealed varying hair characteristics. Lastly, metabolic parameters namely triglyceride, fasting blood glucose, HbA1c and HDL differ significantly, with the normal onset group demonstrating a higher prevalence of metabolic abnormality. This suggests a potential association between AGA and metabolic syndrome. However, the exact nature of this relationship remains uncertain, necessitating further research with larger samples, specific age groups and diverse study designs.
Article
We aimed to determine the efficacy of the various available oral, topical, and procedural treatment options for hair loss in individuals with androgenic alopecia. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the National Library of Medicine was performed. Overall, 141 unique studies met our inclusion criteria. We demonstrate that many over the counter (e.g. topical minoxidil, supplements, low-level light treatment), prescription (e.g. oral minoxidil, finasteride, dutasteride), and procedural (e.g. platelet-rich plasma, fractionated lasers, hair transplantation) treatments successfully promote hair growth, highlighting the superiority of a multifaceted and individualized approach to management.
Article
Full-text available
Background Androgenetic alopecia (AGA) affects both men and women. Standard treatments include topical minoxidil and oral finasteride, which can cause undesirable side effects. Therefore, a natural herbal extract is required for an alternative treatment. Objectives This study aims to assess both the efficacy and safety profiles of an herbal extract comprising a combination of dihydroquercetin glucoside, epigallocatechin gallate glucoside, zinc, and glycine, compared to the minoxidil solution for the treatment of AGA. Methods About 30 males and 30 females were recruited. The males and females were divided equally into two groups (n=30), randomly receiving either a minoxidil solution or herbal extraction twice a day for 24 weeks. Clinical efficacy, total hair count, and hair mass index (HMI) were evaluated. Results A total of 30 males and 30 females completed the study. The total hair counts (hairs/cm ² ) at baseline in the herbal group and minoxidil group were 334.8±108.8 and 368.3±178.4, respectively, and the total hair counts at 24 weeks in the herbal group and minoxidil group were 345.0±119.2 and 391.5±183.1 (p<0.001, p<0.001), respectively. The HMI in the herbal and minoxidil groups significantly increased by 25.83±17.18 and 33.70±15.17 (p=0.001, p<0.001) at 24 weeks. However, there was no significant difference in total hair count and HMI between the two groups at 24 weeks (p= 0.250, p=0.065). No local adverse effects were observed in both groups. Conclusions The non-significant difference in efficacy and safety to minoxidil solution suggests that the herbal extraction could be an alternative treatment for AGA. Clinical Trial Registration Number TCTR20220927001.
Chapter
This chapter reviews acquired hair disorders, including common scarring and non‐scarring alopecia presentations, conditions characterised by excessive body hair growth and acquired hair shaft disorders. We also describe the biology of normal hair follicles, including structure, hair cycle control and immunity, to better understand the mechanisms underlying these conditions. We present methods for clinical assessment, recommended investigation and management of each disease, and present summaries of frequently used therapeutics and cosmetic options employed when treating these problems.
Article
Full-text available
Androgenetic alopecia is a highly prevalent condition mainly affecting men. This complex trait is related to aging and genetics; however, multiple other factors, for example, lifestyle, are also involved. Despite its prevalence, the underlying biology of androgenetic alopecia remains elusive, and thus advances in its treatment have been hindered. Herein, we review the functional anatomy of hair follicles and the cell signaling events that play a role in follicle cycling. We also discuss the pathology of androgenetic alopecia and the known molecular mechanisms underlying this condition. Additionally, we describe studies comparing the transcriptional differences in hair follicles between balding and non-balding scalp regions. Given the genetic contribution, we also discuss the most significant risk variants found to be associated with androgenetic alopecia. A more comprehensive understanding of this pathology may be generated through using multi-omics approaches.
Chapter
As well as quantifying the burden of skin disease, epidemiology provides a direct method for assessing the causes of skin diseases. Identification of causes is a necessary step in pursuing the ultimate goal of disease prevention. This chapter covers the importance of thinking in terms of population rather than individuals, and provides a summary of the substantial global morbidity caused by skin disease. Risk factors from genetics to environment are outlined, along with describing the natural history and associations of common skin diseases. Finally, there is a description of how the principles and data from epidemiological studies provide the cornerstone to planning appropriate dermatology services. The chapter closes by providing the reader with a glossary of terms and a checklist to help with reading epidemiological studies.
Article
Objective: To compare the efficacy of platelet-rich plasma (PRP) versus 5% topical minoxidil for the treatment of androgenetic alopecia (AGA). Study Design: Randomised-controlled trial. Place and Duration of the Study: Department of Dermatology, PNS Shifa Hospital, Karachi, Pakistan, from 1st July 2022. November 2021 to 31st Methodology: Seventy AGA patients aged between 18-60 years of either gender were randomly divided into two groups. Group A was given 5% topical minoxidil and Group B was given PRP. Both groups were followed up over a period of 6 months, and the final analysis was done with the help of global photography, hair pull test, and patient satisfaction score. Results: At the end of 6th month, 27 patients (77%) in Group A had a negative hair pull test as compared to only 14 (40%) in Group B (p = 0.001). In Group A, 32 patients (91.4%) reported improvement in hair scalp from baseline. Whereas, in Group B, 26 patients (74.3%) reported improvement from baseline (p = 1.00). PRP was effective in 26 patients (74.5%) and 5% topical minoxidil in 15 patients (43.7%) (p = 0.007). Conclusion: PRP therapy can be a useful alternative to topical minoxidil in the treatment of AGA.
Article
A previous, proof-of-concept clinical study suggested that dermal sheath cup cell injections into the affected areas of male/female pattern hair loss (PHL) may have some amelioratory effects, the clinical efficacy of which needs further examination. A phase III equivalent clinical study was conducted to further probe the therapeutic potential of this novel approach and verify its safety and efficacy in improving the appearance of PHL. Thirty-six participants with PHL were injected with dermal sheath cup cell harvested from non-affected occipital hair follicles twice in quarterly intervals. Global photographic assessment and phototrichogram were performed in a blinded manner. Patient-reported outcomes were assessed for 12 months. On global photographic assessment, 30% of the participants showed improvement. The analysis of phototricogram data detected the increases in the cumulative hair diameter, hair cross-sectional area, and mean hair diameter of 107.6 ± 152.6 μm/cm2 , 13069.1 ± 10960.7 μm2 /cm2 , and 0.9 ± 0.9 μm (ratios vs. baseline: +1.4%, +3.4%, and +2.2%), respectively. The female and high terminal hair ratio groups achieved better improvement. Of the total participants, 62.9% noted some degree of improvement. No serious adverse events were detected. This novel approach exhibited visible effects while ensuring safety and patient satisfaction. Therefore, it holds promise as a possible therapeutic option for treating PHL, especially in women.
Article
Full-text available
Androgeneticalopecia (AGA) is the most common type of non-scarring alopecia. While global photography is the most commonly employed to track therapeutic efficacy, reflectance confocal microscopy (RCM) is a non-invasive imaging tool that may offer novel insights in tracking treatment progression for AGA. Ten patients with androgenetic alopecia initiating topical combination therapy elected to undergo treatment monitoring of this formulation using global photography and/or reflectance confocal microscopy. All patients had evidence of follicular miniaturization at baseline, and rimmed dermal papillae at both baseline and the end of the study. One patient had follicular miniaturization at baseline but not at the end of the study; however, this patient did not exhibit any changes in their Hamilton Norwood Score. Two patients exhibited inflammatory cells in the epidermis of the frontal scalp and mid-scalp at baseline on RCM that were no longer visible on RCM after 12 weeks of treatment. Of these two patients, one patient had a Hamilton Norwood score that did not improve after treatment, even though inflammatory cells were no longer present post-treatment. RCM offers a novel, non-invasive option for monitoring sub-clinical treatment progress in patients with AGA that can uncover novel insights in patients’ presentation and response to treatment earlier than with global photography.
Article
Androgenetic alopecia (AGA) is a common type of hair loss, which is generally influenced by genetic factors and systemic androgens resulting in follicular miniaturization1. It can cause cosmetic problems leading to psychological distress among affected men and women. Effective standard medical treatments available are topical minoxidil 2-5%, oral finasteride, oral dutasteride, and hair transplantation.1 However, some patients do not achieve favorable results with standard treatments. For these reasons, other novel treatments have been developed, including new medications, regenerative medicines (autologous platelet-rich plasma (PRP), adipose derived stem cells, micrograft generation and exosome) and low-level laser therapy (LLLT).
Article
The hair follicle (HF) is a multicellular complex structure of the skin that contains a reservoir of multipotent stem cells. Traditional hair repair methods such as drug therapies, hair transplantation, and stem cell therapy have limitations. Advances in nanotechnology offer new approaches for HF regeneration, including controlled drug release and HF-specific targeting. Until recently, embryogenesis was thought to be the only mechanism for forming hair follicles. However, in recent years, the phenomenon of wound-induced hair neogenesis (WIHN) or de novo HF regeneration has gained attention as it can occur under certain conditions in wound beds. This review covers HF-specific targeting strategies, with particular emphasis on currently used nanotechnology-based strategies for both hair loss-related diseases and HF regeneration. HF regeneration is discussed in several modalities: modulation of the hair cycle, stimulation of progenitor cells and signaling pathways, tissue engineering, WIHN, and gene therapy. The HF has been identified as an ideal target for nanotechnology-based strategies for hair regeneration. However, some regulatory challenges may delay the development of HF regeneration nanotechnology based-strategies, which will be lastly discussed.
Article
Rationale Androgenic alopecia (AGA) is a prevalent condition with progressive miniaturization of hair follicles. Currently, reliable treatments have remained limited, and complementary medications for AGA are still being investigated. Traditional Chinese medicine formulas have conspicuous advantages in the treatment of AGA with good development prospects. Zimmer aqueous spray (ZAS) is a water spray containing Zimmer herbal extract powder (ZMWP), which consists of Ligustri lucidi Fructus, Ecliptae Herba, Fallopia multiflora (Thunb.) Harald. and Polygonatum sibiricum Delar. ex Redoute , etc. ZMWP is an active ingredient in the prevention of hair loss. Our aim is to provide evidence for the effectiveness of ZAS in the treatment of AGA. Patient concerns A 41-year-old man had suffered from hair loss for 8 years. Interventions The patient with moderate AGA received 3 to 4 mL ZAS daily or every other day for 3 months. Outcomes The hair density obviously increased after 3 months of therapy. The improvement of hair diameter, vellus hair rate, and 1 hair pilosebaceous unit rate were observed with a trichoscopy and quantitatively analyzed. Besides, honeycomb pigment pattern mitigated and arborized red lines. Lessons The results suggested that ZMWP might have the capability of improving hair growth and attenuating AGA, which can be a promising alternative treatment of AGA.
Article
Background Androgenetic alopecia (AGA) is the most common cause of hair loss in males which remains a therapeutic challenge. Objectives To compare the efficacy of topical 5% minoxidil and 0.25% finasteride combination (MNF) over 5% minoxidil (MNX) or 0.25% finasteride (FNS) alone by assessing hair count, physician assessment score (PAS), and patient satisfaction score (PSS). Materials and Methods Pilot randomized open-label study where 60 male patients with AGA ≥ III grade were randomized into three treatment groups and evaluated over 24 weeks. Improvement in hair count was assessed manually using dermoscopy. Global photographs were used to assess PAS. Side effects were evaluated using relevant laboratory investigations. Results At the 12th and 24th week, all three groups showed significant improvement in total hair density as compared to baseline (P < 0.001). None of the groups was superior to the other (P > 0.05) at the 12th week but at 24th week, MNF was comparatively superior (P < 0.02). At the 12th week and 24th week, all three groups showed significant improvement in terminal hair density as compared to baseline (P < 0.001). In the 12th week, MNF was comparatively superior (P = 0.028) and at the 24th week, MNF was comparatively superior (P < 0.02). PAS and PSS were significantly better with MNF and MNX compared to FNS (P < 0.004). Side effects such as scaling and itching were reported with MNF and MNX. Conclusion Topical minoxidil 5% and finasteride 0.25% had an overall better efficacy compared to monotherapy without significant side effects.
Article
Full-text available
Background: Vitiligo is a multifaceted autoimmune depigmenting disorder affecting around 0.5 to 2.0% of individuals globally. Standardizing diagnosis and therapy tracking can be arduous, as numerous clinical evaluation methods are subject to interobserver variability and may not be validated. Therefore, there is a need for diagnostic tools that are objective, dependable, and preferably non-invasive. Aims: This systematic review provides a comprehensive overview of the non-invasive objective skin measurement methods that are currently used to evaluate the diagnosis, severity, and progression of vitiligo, as well as the advantages and limitations of each technique. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used for the systematic review. Scopus, Embase, Cochrane Library, and Web of Science databases were comprehensively searched for non-invasive imaging and biophysical skin measuring methods to diagnose, evaluate the severity of, or monitor the effects of vitiligo treatment. The risk of bias in included articles was assessed using the QUADAS-2 quality assessment scale. Results: An extensive literature search resulted in 64 studies for analysis, describing eight imaging techniques (reflectance confocal microscopy, computer-aided imaging analysis, optical coherence tomography, infrared photography, third-harmonic generation microscopy, multiphoton microscopy, ultraviolet light photography, and visible light/digital photograph), and three biophysical approaches (dermoscopy, colorimetry, spectrometry) used in diagnosing and assessing vitiligo. Pertinent information about functionality, mechanisms of action, sensitivity, and specificity was obtained for all studies, and insights into the strengths and limitations of each diagnostic technique were addressed. Methodological study quality was adequate; however, statistical analysis was not achievable because of the variety of methods evaluated and the non-standardized reporting of diagnostic accuracy results. Conclusions: The results of this systematic review can enhance clinical practice and research by providing a comprehensive overview of the spectrum of non-invasive imaging and biophysical techniques in vitiligo assessment. Studies with larger sample sizes and sound methodology are required to develop verified methods for use in future practice and research.
Article
Both nonsurgical and surgical modalities for the treatment of hair loss are being used by providers at an increasing rate worldwide. Men and woman are affected by hair loss, but the pathophysiology of the hair loss is thought to be different between sexes; therefore, gender must play a role in treatment decisions. Currently, there are 3 Food and Drug Administration-approved nonsurgical androgenetic alopecia treatments: minoxidil, finasteride, and low-light laser therapy. Platelet-rich plasma injections are showing promise as a single modality and as an adjunct to other nonsurgical and surgical treatments of androgenetic alopecia.
Article
Background: Mesotherapy, a technique of transdermal microinjections of specific preparations, is increasingly used in fields such as dermatology and specifically for alopecia treatment. Its popularity stems from its ability to deliver drugs in a targeted manner while minimizing systemic side effects. Objective: To assess and review current knowledge regarding the use of mesotherapy to deliver alopecia medications and highlight future directions for research. Materials and methods: The authors used research databases including PubMed and Google Scholar to identify current literature on mesotherapy and alopecia. The following search terms were used among other terms: "Mesotherapy" or "Intradermal" AND "Alopecia". Results: Recent studies are promising for the intradermal delivery of dutasteride and minoxidil in the treatment of androgenetic alopecia. Conclusion: Although limitations exist with dutasteride and minoxidil therapies, further research regarding the preparation, delivery, and maintenance of these drugs is warranted as mesotherapy could establish this technique as a safe, effective, and viable treatment option for androgenetic alopecia.
Article
A double-blind clinicopathologic study was designed to assess the efficacy and safety of topical minoxidil in the treatment of male-pattern baldness. Twenty-one bald but otherwise healthy male volunteers were randomly assigned (7 per group) to receive a 1% or 5% minoxidil solution in a vehicle of ethanol-water-propylene glycol or the vehicle alone applied twice daily to the bald scalp. The 15 white and 6 black subjects were aged 24 to 46 years. Scalp biopsies were done pretreatment and at weeks 12 and 24 after treatment began. Ten normal subjects from the same population, matched for age, served as controls for histopathologic studies. Increased hair growth was seen in both minoxidil-treated and placebo-treated groups, and there was no statistically significant difference between groups at 15.7 weeks when treatment was discontinued. Hair growth appeared to be limited to hypertrophy of pre-existent follicles; there was no good evidence for follicular neogenesis. It was concluded that topical application of up to 5% minoxidil solution was safe within the limits of this study.
Article
Clinical Pharmacology & Therapeutics (1996) 59, 166–166; doi: 10.1038/sj.clpt.1996.162
Article
Clinical Pharmacology & Therapeutics (1996) 59, 166–166; doi: 10.1038/sj.clpt.1996.164
Article
The ability to photographically document patient progress is especially useful in recording the subtle changes that a hair loss patient may have between office visits. Serial photography (sequential photographs) can be used by both the physician and the patient to assess these changes. Figures 1A and 1B show the therapeutic benefit a patient has achieved in the vertex area of the scalp from an initial to a 6-month follow-up visit. The physician's challenge as the photographer is significant: to take photographs that allow for the assessment of change, and not a critique of photographic technique. Variability in technique, including patient preparation, lighting, camera settings, camera to patient registration, film, and processing can all undermine the best intentions of photographic documentation.High-quality clinical photography can be accomplished in the examination room. With the 35-mm camera equipment you may already have in your office, you can structure a methodic approach for taking reproducible serial photographs. Controlled reproducible serial photographs should read like a time-lapse movie, allowing for only the change in a patient's condition over time. Clinical researchers studying androgenetic alopecia worldwide use controlled photography for primary and secondary endpoints of protocols to determine the efficacy of therapies.
Article
Minoxidil (2–4 diamino-6-piperidine-pyrimidine-5-oxide) is a directacting peripheral arteriolar vasodilator that reduces peripheral vascular resistance. It was first marketed by The Upjohn Company in 1979 as Loniten® Tablets for the treatment of severe hypertension. The peripheral vasodilation caused predictable cardiovascular effects, such as lowered blood pressure, reflex tachycardia, and fluid retention.1 Canine cardiac lesions were reported in toxicology studies, but no such findings are evident in humans.2
Article
The histopathology of androgenetic alopecia is characterized by reductions in follicular size and mean hair shaft diameter without significant reduction in follicular density.1 The proportion of hairs found in anagen is diminished with a corresponding increase in hairs in normal telogen, plus a marked increase in a persistent stage of telogen. The telogen germinal unit is the term given by Headington2 to the structure that represents a persistence of telogen after shedding of the club hair but in which anagen has not been re-established.Regrowth of scalp hair following topical application of minoxidil has been demonstrated in both primates3,4 and humans5,6 suffering from androgenetically determined alopecia. As part of a nationwide multicenter trial of topical minoxidil in male-pattern alopecia, scalp biopsy specimens were obtained before and after treatment to determine what histopathologic changes might be found and if this might help us understand the way in which the clinically observed regrowth of hair might occur.
Article
The challenge of useful serial photographic documentation of hair loss can be met by using a regimented approach at each photographic session. Patient outcomes that are better documented allow for more informed decisions to be made about the course of therapy by both the physician and the patient.
Article
Hair loss is a common and distressing symptom. With the approval of two drugs that promote hair growth — finasteride and minoxidil — we can now treat patients with some types of hair loss. Both drugs influence the hair-growth cycle and increase the length and diameter of existing hair, although their mechanisms of action differ. In this article, I will focus on the treatment of two common problems, androgenetic alopecia and alopecia areata, both of which involve a reversible alteration of the hair-growth cycle. The Hair-Growth Cycle Hair growth is cyclic, with phases of growth (anagen), involution (catagen), and rest . . .
Article
Quantitative estimation of hair growth using hair weight and number was recorded for 120 weeks in 4 groups of 9 men with androgenetic alopecia. Three double-blind groups applied either 2% or 5% minoxidil solution, or vehicle. The fourth group, unblinded, received no treatment. Measurements of hair weight and number were continued for 96 weeks, when treatment (if any) was stopped, though measurements were continued for another 24 weeks. Although not compared statistically, the placebo and untreated groups behaved in a similar fashion. In contrast, the 5% and 2% minoxidil treatment groups showed a statistically significant increase in mean percentage change in interval weight from baseline compared with placebo; results for number counts were usually less significant. Over 96 weeks, topical minoxidil induced and maintained an increase in interval weight over baseline of about 30%. After treatment was stopped, hair weight and number counts for the minoxidil groups returned to about the same levels as placebo in 24 weeks.
Hemody-namiceffectsofminoxidilfollowingintravenousinfusionsinun-treated hypertensive patients [abstract]
  • Jj Ferry
  • Sw Turner
  • Dg Albert
  • Aj Dietz
  • Luderer
Ferry JJ, Turner SW, Albert DG, Dietz AJ, Luderer JR. Hemody-namiceffectsofminoxidilfollowingintravenousinfusionsinun-treated hypertensive patients [abstract]. Clin Pharmacol Ther 1996; 59:166
Disorders of hair growth: diagnosis and treatment
  • E A Olsen
Olsen EA. Androgenetic alopecia. In: Olsen EA, editor. Disorders of hair growth: diagnosis and treatment. New York: McGraw-Hill; 1994. p. 257-83.