Treatment of Androgenetic Alopecia: Current Guidance and Unmet Needs

Abstract

Androgenetic alopecia (AGA) is the most common cause of hair loss in men and women. Traditionally, topical minoxidil and oral finasteride have been the standard of care yielding mixed results. New treatments such as Low-Level Laser Therapy (LLLT), microneedling, platelet-rich plasma (PRP), and others have been extensively studied in the literature, and the purpose of this review is to provide a comprehensive discussion of the latest treatment methods and their efficacy in treating AGA. Novel therapies such as oral minoxidil, topical finasteride, topical spironolactone, botulinum toxin, and stem cell therapy offer interesting alternatives to standard of care therapies for patients. In this review, we present data from recent studies on the clinical efficacy of these treatments. Furthermore, as new treatments have emerged, clinicians have tested combination therapies to assess whether there may be a synergistic relationship between multiple modalities. While there has been a great increase in the treatments available for AGA, the quality of evidence varies greatly and there is still a great need for randomized double blinded clinical trials to adequately assess the clinical efficacy of some treatments. While PRP and LLLT have demonstrated encouraging results, standardized treatment protocols are needed to adequately inform clinicians on how to use such therapies. Given the abundance of new therapeutic options, clinicians and patients must weigh the benefits and risks of each treatment option for AGA.

Keywords: androgenetic alopecia; finasteride; microneedling; minoxidil; platelet rich plasma.

Figure 1

Efficacy of Low-level laser therapy for the treatment of androgenetic alopecia. Reproduced from Suchonwanit P, Chalermroj N, Khunkhet S. Low-level laser therapy for the treatment of androgenetic alopecia in Thai men and women: a 24-week, randomized, double-blind, sham device-controlled trial. Lasers Med Sci. 2019;34(6):1107–1114. Creative Commons Attribution 4.0 International License. (https://creativecommons.org/licenses/by/4.0/).

Figure 2

Before and after of a patient with AGA treated with PRP and microneedling. Reproduced from Aggarwal K, Gupta S, Jangra RS, Mahendra A, Yadav A, Sharma A. Dermoscopic assessment of microneedling alone versus microneedling with platelet-rich plasma in cases of male pattern alopecia: a split-head comparative study. Int J Trichol. 2020;12(4): 156, under the Creative Commons Attribution-Non Commercial-ShareAlike 4.0 License.