P06 Evaluating the efficacy and safety of combined microneedling therapy vs. topical minoxidil in androgenetic alopecia: a systematic review and meta-analysis of randomized controlled trials

Abstract Introduction and aims This study evaluates the efficacy and safety of combined microneedling (CMNT) with minoxidil vs. minoxidil monotherapy for the treatment of androgenetic alopecia (AGA), with a focus on the impact of microneedling parameters on treatment outcomes. Methods We conducted a systematic review and meta-analysis (PROSPERO: CRD42024594487) of randomized controlled trials (RCTs) comparing CMNT vs. minoxidil alone for AGA, following PRISMA guidelines. A comprehensive search across six databases was performed up to 8 September 2024. Results We identified 12 RCTs involving 631 patients with AGA, with a total of 11 RCTs included in the meta-analyses. CMNT significantly improved hair count compared with minoxidil monotherapy [standardized mean difference (SMD) 1.32, 95% confidence interval (CI) 0.73–1.92; P < 0.01], with substantial heterogeneity (I² = 88%, P < 0.01). Subgroup analyses indicated no significant effect of microneedling depth (≤ 1 mm vs. > 1 mm), duration (≤ 12 weeks vs. > 12 weeks) or technique (device) (electrodynamic vs. rolling) on hair count outcomes. Additionally, A meta-analysis of six RCTs demonstrated a significant improvement in hair diameter with CMNT (SMD 0.34, 95% CI 0.11–0.58; P < 0.01), with no observed heterogeneity (I² = 0%). Investigator and patient self-assessment scores were also improved. Adverse events were more frequent with CMNT (74 vs. 59 events); however, they were generally considered mild or self-limiting. Conclusions CMNT significantly enhances hair count and diameter in patients with AGA with mild adverse events. Microneedling parameters including depth, duration and technique variations did not significantly affect hair count outcome, suggesting microneedling as a promising adjunctive AGA treatment.