Evaluating treatments for male androgenetic alopecia: clinical profile and comparative efficacy of platelet rich plasma and minoxidil with finasteride
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20242648Keywords:
AGA, Minoxidil and finasteride solution, Platelet rich plasma, Hair pull testAbstract
Background: Androgenetic alopecia (AGA) is a common, hereditary, and androgen-dependent disorder characterized by progressive hair thinning on the scalp, affecting both men and women. It arises from follicular miniaturization, leading to the conversion of terminal hair into vellus hair.
Methods: This study is a single-center, prospective, open-label, randomized, placebo-controlled trial with four parallel arms designed to evaluate treatments for male pattern baldness. Eighty patients were randomized into four groups: Group 1 received topical minoxidil and finasteride solution, group 2 received PRP alone, group 3 received PRP with minoxidil and finasteride solution, and group 4 received normal saline (NS). Interventions were administered monthly over three months, followed by a three-month follow-up period. Treatment effects were assessed using measures such as patient self-assessment, global photography, and the hair pull test.
Results: Group 3 (Combined treatment) showed the most significant improvement in the hair pull test after six months (73.33% negative tests), followed by group 2 (PRP treatment) with 60% improvement. Patient satisfaction scores were highest in group 3 across all follow-ups (F1 to F5), demonstrating superior treatment response compared to other groups (p<0.001). Global photography assessments indicated varying results among groups, with group 4 recording the highest proportion of fair improvements (58.5%). Group 3 exhibited the highest percentage of patients with above-average improvement.
Conclusions: Our study provides valuable insights into managing AGA, emphasizing the effectiveness of combining PRP with topical treatments compared to individual therapies and placebo.
References
Tosti A, Piraccini BM, Iorizzo M, Voudouris S. The natural history of androgenetic alopecia. J Cosmet Dermatol. 2005;4(1):41-3.
Sakhiya J, Sakhiya D, Modi M, Gandhi S, Daruwala F. Prevalence, severity and associated factor of androgenetic alopecia in the dermatology outpatient clinic: A retrospective study. Indian J Clin Exp Dermatol. 2019;5(4):280-7.
Wang TL, Zhou C, Shen YW, Wang XY, Ding XL, Tian S, et al. Prevalence of androgenetic alopecia in China: A community-based study in six cities. Br J Dermatol. 2010;162(4):843-7.
Tang PH, Chia HP, Cheong LL, Koh D. A community study of male androgenetic alopecia in Bishan. Singapore. Singapore Med. J. 2000;41(5):202-5.
Paik JH, Yoon JB, Sim WY, Kim BS, Kim NI. The prevalence and types of androgenetic alopecia in Korean men and women. Br J Dermatol. 2001;145(1):95-9.
Garg S, Manchanda S. Platelet-rich plasma-an 'Elixir' for treatment of alopecia: personal experience on 117 patients with review of literature. Stem Cell Investig. 2017;4:64.
Kibar M, Aktan S, Bilgin M. Scalp dermatoscopic findings in androgenetic alopecia and their relations with disease severity. Ann Dermatol. 2014;26(4):478-84.
Hamilton JB. Patterned loss of hair in man; types and incidence. Ann N York Academy Sci. 1951;53(3):708-28.
Norwood OT. Male pattern baldness: classification and incidence. Southern Med J. 1975;68(11):1359-65.
Van Neste D, Fuh V, Sanchez Pedreno P, Lopez-Bran E, Wolff H, Whiting D, et al. Finasteride increases anagen hair in men with androgenetic alopecia. Br J Dermatol. 2000;143(4):804-10.
Vanderveen EE, Ellis CN, Kang S, Case P, Headington JT, Voorhees JJ, et al. Topical minoxidil for hair regrowth. J Am Acad Dermatol. 1984;11(3):416-21.
Hussein SM, Soliman AM, Abd El-Alim SH. Assessment of the efficacy of topical antiandrogen; spironolactone in patients with androgenetic alopecia by dermoscopy. J Pak Assoc Dermatol. 2022;32(3):493-501.
Zhou Y, Yu S, Zhao J, Xinyue F, Meinan Z, Zigang Z. Effectiveness and safety of botulinum toxin type A in the treatment of androgenetic alopecia. Biomed Res Int. 2020;2020:1-7.
Mester E, Szende B, Gartner P. The effect of laser beams on the growth of hair in mice. Radiobiol Radiother. 1968;9:621-6.
Zito PM, Raggio BS. Hair Transplantation. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2024.
Andia I, Abate M. Platelet-rich plasma: Underlying biology and clinical correlates, Regen Med. 2013;8:645-58.
Andia I. Platelet-rich plasma biology. In: Alves R, Grimalt R, editors. Clinical Indications and Treatment Protocols with Platelet-Rich Plasma in Dermatology. Barcelona: Ediciones Mayo. 2016;3-15.
Scully D, Naseem KM, Matsakas A. Platelet biology in regenerative medicine of skeletal muscle. Acta Physiol. 2018;223(3):e13071.
Nguyen RT, Borg-Stein J, McInnis K. Applications of platelet-rich plasma in musculoskeletal and sports medicine: An evidence-based approach. PM R. 2011;3(3):226-50.
Whitman DH, Berry RL, Green DM. Platelet gel: an autologous alternative to fibrin glue with applications in oral and maxillofacial surgery. J Oral Maxillofac Surg. 1997;55(11):1294-9.
Akiyama M, Smith LT, Holbrook KA. Growth factor and growth factor receptor localization in the hair follicle bulge and associated tissue in human fetus. J Invest Dermatol. 1996;106(3):391-6.
Khatu SS, More YE, Gokhale NR, Chavhan DC, Bendsure N. Platelet-rich plasma in androgenic alopecia: Myth or an effective tool. J Cutan Aesthet Surg. 2014;7(2):107.
Singh SK, Kumar V, Rai T. Comparison of efficacy of platelet-rich plasma therapy with or without topical 5% minoxidil in male‐type baldness: A randomized, double‐ blind placebo control trial. Indian J Dermatol Venereol Leprol. 2020;86(2):150-7.
Gowda A, Sushmitha KC, Chandra KS. Comparative study of efficacy of topical minoxidil versus topical minoxidil with finasteride in androgenetic alopecia. Int J Res Dermatol. 2021;7(3):378-82.
Olsen EA. Hair loss in childhood. In: Olsen EA, editor. Disorders of hair growth.Diagnosis and treatment. 2nd ed. New York: McGraw Hill. 1994;177-238.
Shankar DK, Chakravarthi M, Shilpakar R. Male androgenetic alopecia: Population- based study in 1,005 subjects. Int J Trichol. 2009;1(2):131-3.
Gupta S, Revathi TN, Sacchidanand S, Nataraj HV. A study of the efficacy of platelet- rich plasma in the treatment of androgenetic alopecia in males. Indian J Dermatol Venereol Leprol. 2017;83:412.
Verma K, Tegta GR, Verma G, Gupta M, Negi A, Sharma R. A study to compare the efficacy of platelet-rich plasma and minoxidil therapy for the treatment of androgenetic alopecia. Int J Trichology. 2019;11:68-79.
Agarwal P, Gajjar KM, Jagati A, Chaudhari SV, Rathod SP. Platelet-Rich Plasma in Androgenetic Alopecia: Is It Really Worth the Hype? Int J Trichol. 2023;15(3):98-104.
30. Hajheydari Z, Akbari J, Saeedi M, Shokoohi L. Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Indian J Dermatol Venereol Leprol. 2009;75:47-51.
Shah KB, Shah AN, Solanki RB, Raval RC. A Comparative Study of Microneedling with Platelet-rich Plasma Plus Topical Minoxidil (5%) and Topical Minoxidil (5%) Alone in Androgenetic Alopecia. Int J Trichol. 2017;9(1):14-18.
Krupa Shankar D, Chakravarthi M, Shilpakar R. Male androgenetic alopecia: population-based study in 1,005 subjects. Int J Trichol. 2009;1(2):131-3.
