A Randomized Controlled, Single-Observer Blinded Study to Determine the Efficacy of Topical Minoxidil plus Microneedling versus Topical Minoxidil Alone in the Treatment of Androgenetic Alopecia

Abstract

Background: Androgenetic alopecia (AGA) is the most common form of hair loss in adults, which is generally progressive in the absence of treatment. As a head full of healthy hair adds to the cosmetic appeal of the individual, the consequences of AGA are predominantly psychological. Currently, topical minoxidil is the first-line treatment for AGA. Many adjuvant treatment modalities have been used synergistically with minoxidil. Microneedling is one among such adjuvant treatments, which works by various mechanisms to stimulate the dermal papillary cells that play a key role in hair growth.

Aim: To compare the efficacy of microneedling along with topical minoxidil and topical minoxidil alone in the treatment of AGA in men.

Materials and methods: Sixty-eight men with Norwood-Hamilton grade III and IV AGA were recruited for the study. After randomization, one group was treated with weekly microneedling and twice daily application of 5% minoxidil solution and the other group was treated with twice daily application of 5% minoxidil solution alone. Global photographs were taken at baseline (pretreatment) and at end of the study duration. Trichoscopic images were taken from a targeted fixed area before treatment (baseline) and at end of the therapy from where hair count was also carried out. The two primary efficacy parameters were assessed: increase in the hair count from that of the baseline and patient self-assessment of hair growth at the end of the study.

Results: The mean increase in hair count in the targeted area of one square inch at the end of the treatment was significantly greater for the combination treatment group (12.52/inch²) compared to that for the minoxidil alone group (1.89/inch²). Four patients in the "microneedling plus topical minoxidil" group reported a 50% improvement versus none in the "minoxidil alone" group.

Conclusion: Our study showed that the combination of microneedling and topical minoxidil treatment was superior compared to topical minoxidil alone with regard to increase in the hair count and patient satisfaction, although the response achieved was not cosmetically significant.

Keywords: Androgenetic alopecia; microneedling; trichoscopy.

Figure 1

Area on vertex of the scalp to be used for hair count. Same distance from glabella, occiput, and laterally from the tips of both the ear helices was measured at each session to ensure uniformity. a: distance from glabella to vertex, b: distance from occiput to vertex, c and d: distance from the helix of the ear to vertex on the right and left sides respectively

Figure 2

Pretreatment (A) and posttreatment (B) comparison showing improvement in the hair volume in the combination treatment group

Figure 3

Pretreatment (A) and posttreatment (B) comparison showing improvement in the hair volume in the “minoxidil alone” group

Figure 4

Pretreatment (A) and posttreatment (B) trichoscopic analysis in the combination treatment group revealed a significant increase in the hair count (original magnification ×10)

Figure 5

Pretreatment (A) and posttreatment (B) trichoscopic analysis in the “minoxidil alone” group also revealed increase in the hair count but not as significantly as in the combination group (original magnification ×10)