A Randomised Controlled Single Observer Blinded Study To Determine The Efficacy Of Topical Minoxidil Plus Microneedling Versus Topical Minoxidil In The Treatment Of Androgenetic Alopecia

Abstract

Background: Androgenetic alopecia is a genetically predisposed androgen induced pattern of progressive hair loss. Dermal papilla (DP) is the site of expression of various hair growth related genes. According to various studies Wnt proteins and wound growth factors help in stimulating DP associated stem cells. Microneedling works by stimulation of stem cells and inducing activation of growth factors. Minoxidil causes increased expression of VEGF mRNA and activates β-catenin activity in the DP cells. Objectives: Objective of this study was to study the effect of microneedling technique along with topical minoxidil versus minoxidil in male androgenetic alopecia. Materials and method: Sixty eight men with grade III and IV androgenetic alopecia (AGA) were recruited into 2 groups. After randomization one group was offered weekly microneedling treatment with twice daily 5% minoxidil lotion (study group); other group was given only 5% minoxidil lotion (control group). Baseline global photographs were taken. Dermoscopic images were taken from a 1 cm targeted fixed area at baseline and at end of therapy (week 12) from where hair count was done. The 2 primary efficacy parameters assessed were: Increase from baseline hair count at 12 weeks and patient self assessment of hair growth at 12 weeks. Two blinded investigators evaluated response on computer screen using dermoscopic images. Patient‟s self perception regarding hair growth was assessed by 10 inch long visual analogue scale. XI Results: (1) Hair counts – The mean increase in hair count at week 12 was significantly greater for the study group compared to the control group (12.52 vs 1.89 respectively). (2) Patient evaluation – In the study group, 4 (12.9%) patients reported 50% improvement versus none in the control group. Conclusion: Dermaroller along with Minoxidil treated group was superior to minoxidil treated group in promoting hair growth in men with AGA for 2 primary efficacy parameters of hair growth, the response achieved is not cosmetically significant. However, the total number and frequency of sessions and long-term sustainability of response of microneedling need to be evaluated within a larger population. Microneedling in combination with minoxidil is a safe and a promising therapy to treat hair loss refractory to minoxidil monotherapy.