The Effectiveness and Safety of Three Treatment Regimens of Topical Minoxidil 5.0%, Betamethasone 0.064% w/w, and Castor and Jojoba Oils for Alopecia Areata: A Multicenter Cohort Study

Introduction: Alopecia areata (AA) is a chronic, remitting–relapsing dermatological disease that is associated with a substantial psychological impact. Despite the availability of a wide range of therapeutic options, none provides a cure for AA. This study aimed to compare the effectiveness of topical betamethasone as a monotherapy with combinations of topical betamethasone with either topical minoxidil 5% or a herbal preparation of castor and jojoba oils. Methods: This was a multicenter, cohort study in which patients diagnosed with AA were taking one of three treatment regimens: a reference monotherapy of topical betamethasone 0.064% w/w; combined topical minoxidil and betamethasone 0.064% w/w; or combined topical betamethasone 0.064% w/w and a herbal preparation of castor and jojoba oils. The data were collected at the beginning of the study using a questionnaire. Patients were assessed at three follow‐up visits for hair regrowth using trichoscopy as the primary outcome. Patient satisfaction and compliance were assessed using 10‐point scales. Results: The final sample consisted of 278 patients. Combined topical minoxidil–betamethasone therapy was significantly associated with higher rates of hair regrowth ( p = 0.006), patient satisfaction ( p < 0.001), and shorter median time to first improvement ( p < 0.001). Combined minoxidil/betamethasone was more likely to achieve hair regrowth than the other two treatments at the multivariate level (aRR = 2.239, CI = 1.153–4.347). Moreover, hair regrowth was significantly different between the treatment groups after each phase, with hair regrowth at the final phase observed in 83.2% of patients using combined topical minoxidil and betamethasone. Conclusions: The use of topical minoxidil–betamethasone combination for AA was superior to betamethasone monotherapy or combined with herbal preparations. Randomized clinical trials are needed to strengthen the evidence.