Introduction

Androgenetic alopecia (AGA) is the most prevalent form of hair loss, and available treatment options are limited which include minoxidil and finasteride, as well as procedures such as microneedling (MN). 

Aim

To determine the effectiveness and safety of the combination therapy of microneedling and topical 5% minoxidil in AGA. 

Patient profile

• Male diagnosed with AGA
• Age 18-59 years, diagnosed with AGA type III - VI based on Hamilton-Norwood scale

Methods

• Randomized controlled clinical trial
• 36 AGA patients were randomized to either
  • Intervention group: combination therapy of MN and topical minoxidil 5%
    • Subjects received MN therapy every 4 weeks (weeks 0, 4, and 8) and applied 5% minoxidil twice daily for 12 weeks
  • Control group: topical 5% minoxidil therapy (twice daily for 12 weeks)
• Study Duration: 12 weeks
• Evaluations were performed at weeks 0, 4, 8, and 12. Upon each visit, patients underwent physical examination, and trichoscale examination.
• Trichoscale examination gives measures of hair density, hair diameter percentage of terminal and vellus hairs

Results

• Most of the subjects had AGA severity of III (41.6%), followed by III vertex (19.4%), IV (16.7%), VI (13.8%), and V (8.3%)
• The mean hair density varied from 70.3±24.1 to 96.8±18.9 hair/cm², whereas the mean diameter was 30.2±3 µm
• Hair pulls test was negative in all subjects

Effectiveness

Effect on hair density

• Hair density increased in both the intervention and control groups at each follow-up assessment, indicating a positive trend in hair growth for all participants.
• After 12 weeks, the intervention group exhibited a mean hair density of 175.8 hairs/cm², compared to 156.3 hairs/cm² in the control group.
• The mean increase in hair density was significantly greater in the intervention group (95.6 hairs/cm²) than in the control group (52.4 hairs/cm²), with a statistically significant difference between the two groups (p<0.001).

Figure 1 Mean increase in hair density

 Effect on hair diameter

• At the 12-week mark, the intervention group demonstrated a greater increase in hair diameter compared to the control group, with measurements of 18 µm and 6 µm, respectively
• The mean difference in hair diameter between the intervention and control groups was statistically significant at the conclusion of the study (p=0.004)

Change in terminal and vellus hair

• After 12 weeks, the mean percentage of terminal hair in the intervention group was 73.2%, whereas in the control group it was 58.8%
• The intervention group showed a mean percentage of vellus hair of 26.8%, whereas the control group's median percentage of vellus hair was higher at 41.1%

Safety

• Side effects and adverse events were evaluated at weeks 4, 8 &12, revealing that 25% of participants experienced side effects, comprising six individuals from the intervention group and three from the control group.
• The predominant side effect reported was itching (22.2%) associated with minoxidil use, primarily occurring during the initial phase and not impacting daily activities.
• However, all side effects were well tolerated.

 Conclusion

The combination of 4-weekly microneedling and topical 5% minoxidil was effective in enhancing both hair density & hair diameter, demonstrating safety for patients with androgenetic alopecia (AGA).

Reference

Dermatology Reports 2024; 16:9945