Treatment of Androgenetic Alopecia: Current Guidance and Unmet Needs

Figures & data

Table 1 Summary of Major Studies for AGA Treatments

Topical Minoxidil	Experimental Design	Number of Patients	Experimental Groups	Results	Adverse Effects
Olsen et al^Citation18	48 week double blinded, placebo controlled	393 men with AGA	Group 1: 5% topical minoxidil BID (157 patients) Group 2: 2% topical minoxidil BID (158 patients) Group 3: Placebo (78 Patients)	Earlier treatment response in Group 1 Group 1 increased nonvellus hair count compared to Group 2	Application site dermatitis, pruritis, headache most common in Group 1 (6% of patients) compared to Group 2 (2% of patients)
Goren et al^Citation21	6 month prospective study	15 patients with AGA	All patients received topical 5% minoxidil BID	Sulfotransferase assay predicted responders to 5% topical minoxidil Sensitivity was 100%, specificity was 71%	None
Olsen et al^Citation23	Cross over study	31 male patients with AGA	All patients received topical 3% minoxidil BID for 5 years	Hair growth peaked at 1 year Mean vellus hairs decreased at 4 and 5 years (p=0.012) 9 patients reported increase in mean vellus hairs greater at 5 years than at 1 year	Abrupt discontinuation of minoxidil resulted in hair loss back to baseline
Lucky et al^Citation19	48-week, double-blind, placebo-controlled, randomized trial	381 women with AGA	Group 1: Topical 5% minoxidil solution BID(n=153) Group 2: 2% topical minoxidil solution BID(n=154) Group 3: Topical Placebo BID (n=74)	Group 1 demonstrated a statistically significant (p=0.031) increase in non-vellus hair count compared to Group 2 at 48 weeks	Pruritis, dermatitis, hypertrichosis were most prevalent in Group 1 (14% of patients) compared to Group 2 (6% of patients)
LLLT	Experimental Design	Number of Patients	Experimental Groups	Results	Adverse Effects
Munck et al^Citation26	Retrospective observational study	32 patients with AGA	6 patients received monotherapy with Hairmax Laser Comb (655nm) 3 times weekly for 8–15mins for 24 months 26 patients received combined therapy with LLLT and topical 5% minoxidil or oral finasteride	86% of monotherapy patients showed moderate to significant improvement 85% of combined therapy showed moderate to significant improvement	No adverse reported
Qiu et al^Citation27	Prospective study	1383 patients with AGA	Group 1: LLLT monotherapy for 38–40 weeks Group 2: LLLT with minoxidil for 38–40 weeks Group 3: LLLT with finasteride for 38–40 weeks	Overall clinical effectiveness was 80% Combined therapy reduced oil secretion, improved hair diameter, and hair density better than monotherapy	No adverse reported
PRP	Experimental Design	Number of Patients	Experimental Groups	Results	Adverse Effects
Gkini et al^Citation28	Prospective Cohort Study	20 patients with AGA	PRP preparation: 20 Single Spin with activation 20 patients received 3 treatment sessions every 21 days with a booster session at 6 months	Hair loss stopped at 3 months Hair density peaked at 3 months(p<0.001) Hair regrowth was statistically significant at 6 months(p<0.001) and 1 year (p<0.001) compared to baseline	25% of patients felt mild pain which subsided after 4 hours 60% of patients had scalp sensitivity
Singhal et al^Citation29	Randomized controlled study	20 patients with AGA	PRP Preparation: two-spin method with an activator Group 1: 10 patients received 8–12 cc of PRP every 2 weeks for 4 total sessions Group 2: 10 patients received no PRP	After 3 months, all patients demonstrated increases in hair growth, hair thickness, and hair root strength	3 patients had mild headache after procedure
Verma et al^Citation30	Prospective Randomized controlled study	40 patients with AGA	PRP Preparation: Double Spin with an activator Group 1: 20 patients received monthly PRP injections for 4 months Group 2: 20 patients received topical 5% minoxidil for 4 months	Group A demonstrated better regrowth on global photography compared to Group B Hair pull test was improved in both groups with no statistically significant difference between groups	Pain at injection site causing 4 patients to drop out of study Mild scaling of scalp in Group B
Microneedling	Experimental Design	Number of Patients	Experimental Groups	Results	Adverse Effects
Dhurat et al^Citation31	Randomized single blinded	100 patients with AGA	Group 1: Weekly microneedling with 5% topical minoxidil for 12 weeks Group 2: Topical 5% minoxidil for 12 weeks	Group 1 demonstrated statistically significant increase in hair count compared to Group 2 (p=0.039)	No adverse effects reported
Starace et al^Citation32	Open label non randomized pilot study	50 patients with AGA	All patients received 3 treatments of microneedling over 4 months in addition to topical or systemic AGA therapy	Hair pull tests improved in all patients 7 patients demonstrated significant improvement in hair growth	Scalp pain during microneedling with mild erythema

Figure 1 Efficacy of Low-level laser therapy for the treatment of androgenetic alopecia. Reproduced from Suchonwanit P, Chalermroj N, Khunkhet S. Low-level laser therapy for the treatment of androgenetic alopecia in Thai men and women: a 24-week, randomized, double-blind, sham device-controlled trial. Lasers Med Sci. 2019;34(6):1107–1114. Creative Commons Attribution 4.0 International License. (https://creativecommons.org/licenses/by/4.0/).⁷⁵

Figure 2 Before and after of a patient with AGA treated with PRP and microneedling. Reproduced from Aggarwal K, Gupta S, Jangra RS, Mahendra A, Yadav A, Sharma A. Dermoscopic assessment of microneedling alone versus microneedling with platelet-rich plasma in cases of male pattern alopecia: a split-head comparative study. Int J Trichol. 2020;12(4): 156, under the Creative Commons Attribution-Non Commercial-ShareAlike 4.0 License.¹⁰⁶

Olsen EA, Dunlap FE, Funicella T, et al. A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol. 2002;47(3):377–385. doi:10.1067/mjd.2002.124088

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Goren A, Shapiro J, Roberts J, et al. Clinical utility and validity of minoxidil response testing in androgenetic alopecia. Dermatol Ther. 2015;28(1):13–16. doi:10.1111/dth.12164

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Olsen EA, Weiner MS, Amara IA, et al. Five-year follow-up of men with androgenetic alopecia treated with topical minoxidil. J Am Acad Dermatol. 1990;22(4):643–646. doi:10.1016/0190-9622(90)70089-Z

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Lucky AW, Piacquadio DJ, Ditre CM, et al. A randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss. J Am Acad Dermatol. 2004;50(4):541–553. doi:10.1016/j.jaad.2003.06.014

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Munck A, Gavazzoni MF, Trüeb RM. Use of low-level laser therapy as monotherapy or concomitant therapy for male and female androgenetic alopecia. Int J Trichology. 2014;6(2):45. doi:10.4103/0974-7753.138584

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Qiu J, Yi Y, Jiang L, et al. Efficacy assessment for low-level laser therapy in the treatment of androgenetic alopecia: a real-world study on 1383 patients. Lasers Med Sci. 2022;37:1–6.

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Gkini M-A, Kouskoukis AE, Tripsianis G, et al. Study of platelet-rich plasma injections in the treatment of androgenetic alopecia through an one-year period. J Cutan Aesthet Surg. 2014;7(4):213. doi:10.4103/0974-2077.150743

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Singhal P, Agarwal S, Dhot P, et al. Efficacy of platelet-rich plasma in treatment of androgenic alopecia. Asian J Transfus Sci. 2015;9(2):159. doi:10.4103/0973-6247.162713

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Verma K, Tegta G, Verma G, et al. A study to compare the efficacy of platelet-rich plasma and minoxidil therapy for the treatment of androgenetic alopecia. Int J Trichology. 2019;11(2):68. doi:10.4103/ijt.ijt_64_18

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Dhurat R, Sukesh MS, Avhad G, et al. A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study. Int J Trichology. 2013;5(1):6. doi:10.4103/0974-7753.114700

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Starace M, Alessandrini A, Brandi N, et al. Preliminary results of the use of scalp microneedling in different types of alopecia. J Cosmet Dermatol. 2020;19(3):646–650. doi:10.1111/jocd.13061

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Suchonwanit P, Chalermroj N, Khunkhet S. Low-level laser therapy for the treatment of androgenetic alopecia in Thai men and women: a 24-week, randomized, double-blind, sham device-controlled trial. Lasers Med Sci. 2019;34(6):1107–1114. doi:10.1007/s10103-018-02699-9

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Aggarwal K, Gupta S, Jangra R, et al. Dermoscopic assessment of microneedling alone versus microneedling with platelet-rich plasma in cases of male pattern alopecia: a split-head comparative study. Int J Trichology. 2020;12(4):156. doi:10.4103/ijt.ijt_64_20

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