Intradermal Botulinum Toxin A versus Intradermal Minoxidil in the Management of Androgenetic Alopecia: A Comparative Study

Abstract Androgenetic alopecia (AGA) is one of the most frequent clinical complaints encountered by dermatologists. The two most common treatments for AGA are topical minoxidil and finasteride. Several new therapies are emerging or being studied as treatment options for AGA, including PRP injections, intralesional injection of latanoprost. The aim of our study was to assess the efficacy of intradermal minoxidil versus botulinum toxin A in the treatment of AGA. The study was conducted on thirty patients attending the dermatology clinic complaining of AGA. Participants were divided into two groups (15 per group), group A receiving intradermal BTA injections and group B receiving intradermal minoxidil. The participants received one session every 4 weeks for a total of 3 sessions. Follow-up for the patients was done at every session and 12 weeks after last session. Comparison between BTA and minoxidil groups regarding assessment of total, terminal, vellus hair count and terminal/vellus ratio at baseline and 20 weeks of follow up showed no statistically significant difference. Comparison among BTA, the terminal hair count medians were 103, 116, 117, and 157 with a P value 0.003 showing highly statistically significant increase at each follow up visit. Comparison among Minoxidil group at different times of assessment revealed highly significant difference regarding the count of total, terminal, vellus hair and terminal/vellus hair ratio. Regarding the total hair count, the median count was 164, 135, 155, and 176 respectively, with a P value less than 0.001. In the BTA group, 53.3% and in the minoxidil group, 66.7% had an improvement in the total hair count from baseline to 20 weeks. There was significant negative correlation between the terminal hair percent of change (between baseline and 20 weeks) and age in both groups, in BTA group (p = 0.004) and in minoxidil group (P = 0.049). In BTA group, there was significant negative correlation between duration of AGA and % of change from baseline to 20 weeks regarding total count (p = 0.048). Digital and dermoscopic images were taken for AGA patients included in the study, to demonstrate their progress at different treatment times. Conclusion Both intradermal botulinum toxin A and intradermal minoxidil are equally effective treatment modalities of AGA. They are advantageous due to minimal invasiveness and absence of major side effects. Minoxidil is of an affordable cost compared to BTA, therefore, can be considered to be more cost-effective.