Comparison between Topical Minoxidil 5% Alone versus Combined with Dutasteride (Topical 0.02% through Microneedling or Oral 0.5 mg) in Treatment of Androgenetic Alopecia

Abstract Background Androgenetic alopecia (AGA) in both males and females is considered as the most common hair loss disorder. The importance of this disease comes from intense psychological and emotional distress and disrupted self-image caused by hair loss where there is progressive nonscarring replacement of terminal hair follicles over the frontal and vertex regions by miniaturized follicles, which leads progressively to a visible reduction in hair density. Aim of the Work To assess and compare between the clinical efficacy and safety of topical Minoxidil 5% alone or either with Dutasteride topical 0.02% (through Microneedling) or oral Dutasteride (0.5 mg) in treatment of AGA. Patients and Methods This study was done on 30 patients (24 males and 6 females) with AGA, which were distributed randomly, equally, and blindly into 3 treatment groups (A, B, and C). All were subjected to detailed history taking, examination, and grading. Each patient was instructed to use topical Minoxidil 5% lotion twice daily for 16 weeks in all groups (A, B and C). In addition, group B patients were instructed to use oral Dutasteride 0.5 mg once daily for 16 weeks. Also, Patients in group C were subjected to once per month, of microneedling with topical Dutasteride 0.02% for 4 successive sessions. Furthermore, digital scalp photographs and trichoscope assessment before treatment and at weeks 4,8,12,16 week was done to assess treatment response, as well as 24 week to assess durability of treatment. Also, assessment of patient’s satisfaction, clinical assessment by the physicians through comparing patients' digital photographs, and possible side effects were recorded at the end of treatment (week 16). Results The obtained data from objective parameter regarding hair density, and hair width caliber (through tricoscan) along with subjective parameter regarding patient’s satisfaction including side effects, and physician assessment were tabulated and statistically analyzed. Our study showed clinically significant improvement results in all groups (group C, showed the highest improvement, but group A had the lowest adverse effect profile). This suggests that the novel use of topical Dutasteride (0.02%) through microneedling sessions along with daily use of topical Minoxidil 5% has better result with less systemic side effects than oral Dutasteride (0.5 mg) along with daily use of topical Minoxidil 5%. Moreover, groups B and C showed better results in median hair density and hair width caliber after 16 weeks of treatment. Thus, proofing more efficacy of combined treatment than monotherapy. Although, probably more side effects. In addition, our study showed better results regarding treatment durability in groups B & C more than group A in preserving hair density, while same durability results found in all groups regarding hair width caliber 8 weeks after end of treatment. Conclusion Topical Minoxidil 5% either as montherapy or combined with oral 0.5 mg or topical 0.02% Dutasteride is effective and safe in treating AGA in both males and females. Topical Dutasteride through microneedling is a promising therapy in treatment of AGA of both sexes that may offer same or better results than systemic Dutasteride with negligible side effects.