Comparative Study between Mesotherapy and Topical 5% Minoxidil by Dermoscopic Evaluation for Androgenic Alopecia in Male: A Randomized Controlled Trial

Abstract

Aim: This study aims to compare efficacy and safety between mesotherapy (intralesional injection) and 5% topical minoxidil solution in male androgenic alopecia (AGA) by dermoscopic evaluation.

Methodology: In a randomized active controlled trial, we enrolled 49 clinically diagnosed males of AGA and randomly allotted them into two groups - mesotherapy (A) (25) and minoxidil (B) (24). Males in Group A were given total 8 sessions of intralesional mesosolution with microneedling procedure while Group B males were prescribed topical solution of minoxidil 5% twice daily for 4 months. Results were evaluated at baseline and then monthly for 4 months with clinical photographs, dermoscopy, trichoscan, 7-point standard assessment tool, and patient-self assessment scores.

Results: Grade II was the most common presentation in our study. All dermoscopic parameters such as variation of hair shaft diameter, follicular units with single and multiple hairs, yellow dots, and perifollicular halo did not show any significant difference between the groups at all time points except at 1^st month where the difference in variation of hair shaft diameter between the two group was 0.04. We observed a significant increase (P = 0.01) in the variation of hair shaft diameter between pre- and post-treatment in mesotherapy group compared to minoxidil group. The rest of parameters failed to show any significant difference within the group in mesotherapy and minoxidil.

Conclusion: In our study, we observed a significant increase in the variation of hair shaft diameter between pre- and post-treatment in Group A compared to B. Other dermoscopic, trichoscan, and subjective measurement tool failed to show significant difference between two groups. Our observation suggests that there is no significant improvement of mesotherapy in male AGA over minoxidil.

Keywords: Androgenic alopecia; mesotherapy; trichoscopy.

Figure 1

Derma roller and mesosolution

Figure 2

Heine 20 × dermoscope with trichoscan

Figure 3

Kodak A4 print with dermoscopic picture

Graph 1

Distribution of patients (n) based on grades of androgenic alopecia

Graph 2

Demonstrates the distribution of 50% data of four dermoscopic parameters (represented inside the box) in both the Groups (A and B) at all time periods. Here, the partition line (__) inside the box represents the median value. (^⊥) indicates the minimum and maximum values of data. Variation in hair shaft diameter (%) - A. Variation of hair shaft diameter - B. Follicular units with 1 hair - A. Follicular units with 1 hair - B. Follicular units with >1 hairs - A. Follicular units with >1 hairs - B. Yellow dots - A. Yellow dots - B

Figure 4

Dermoscopy as a monitoring tool in mesotherapy. (a and b) Dermoscopy findings after improvement. (a) Pretreatment. (b) Posttreatment. There is an increase in the number of hairs with treatment. While there is no change in the number of follicular units with single and multiple hairs and perifollicular halo. (c and d) Dermoscopy findings after slight improvement. (c) Pretreatment. (d) Posttreatment. There is minimal change in the number of hairs and follicular units with single hairs. Thin hairs (black arrow), thick hairs (arrow head), variation in hair shaft diameter is >20% varying size and shape of yellow dots (black circle) in interfollicular area and around the miniaturized hair follicle, predominance of follicular units with single hairs, follicular units with >1 hairs (red arrow head), perifollicular halo (white arrows)

Figure 5

Appearance of black dots postmesotherapy procedure. (a) Baseline, (b) 1^st month, (c) posttreatment. Appearance of black dots (black arrow) at 1^st month postmesotherapy procedure is due to microhemorrhage due to multiple trauma which later disappears

Figure 6

Dermoscopy as a monitoring tool in minoxidil. (a and b) Dermoscopic findings after improvement. (a) Pretreatment. (b) Posttreatment. There is an increase in the number of hairs with treatment while there is no change in the number of follicular units with single and multiple hairs and yellow dots. (c and d) Dermoscopic findings after slight improvement. (c) Pretreatment. (d) Posttreatment. There is no major change in the number of hairs, yellow dots, and perifollicular halo. Light yellow dots of varying size are seen. Thin hairs (black arrow) thick hairs (arrow head), variation in hair shaft diameter is >20%, yellow dots (black circle) predominance of follicular units with single hairs, follicular units with >1 hairs (red arrow head), perifollicular halo (white arrows)

Figure 7

Clinical photographs over frontal region of both the groups. (a) Pretreatment: (A) mesotherapy, (B) minoxidil. (b) Posttreatment: (A) mesotherapy, (B) minoxidil

Figure 8

Clinical photographs over vertex region of both the groups. (a) Pretreatment: (A) mesotherapy, (B) minoxidil. (b) Posttreatment: (A) mesotherapy, (B) minoxidil