Minoxidil: a comprehensive review

Gupta, Aditya K.; Talukder, Mesbah Uddin; Venkataraman, Maanasa; Bamimore, Mary A

doi:10.1080/09546634.2021.1945527

Cited by 64 publications

(60 citation statements)

References 99 publications

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“…The most common cause of losing hair in men is androgenetic alopecia (AGA) 1–3 . Approximately 70% of men suffer from AGA during their lifetimes 1 . Elevated levels of free testosterone and dihydrotestosterone (DHT) are observed in males with AGA 4 .…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, topical minoxidil is approved for both men and women 1 . However, both drugs require long‐term applications to observe improvement 1,2 . Some patients experience sub‐optimal improvement due to limited efficacy 1,2 .…”

Section: Introductionmentioning

confidence: 99%

“…A high DHT level may act on the hair follicle to cause miniaturization 4,5 . Topical minoxidil and oral finasteride are the only FDA‐approved treatments for AGA 1,2 . Oral finasteride is approved for male pattern hair loss only, but it has been used off‐label in postmenopausal women 2 .…”

Section: Introductionmentioning

confidence: 99%

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Natural products for male androgenetic alopecia

Gupta

Talukder

Bamimore

2022

Dermatologic Therapy

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Androgenetic alopecia (AGA) is the most common cause of hair loss in men, often requiring medical attention. The US FDA approved topical minoxidil and oral finasteride to treat AGA. Topical minoxidil requires a long‐term application to observe improvement; oral finasteride may cause undesirable side effects. Therefore, natural products may be an alternative when patients are skeptical about these two conventional treatments. Physicians may also suggest natural products in conjunction with topical minoxidil or oral finasteride to enhance clinical outcomes. This article reviews the prospect of natural products in treating male AGA. A systematic search was conducted in PubMed, CINAHL, Scopus, Web of Science, and EMBASE (Ovid) on July 19, 2021. In addition, the bibliographies of selected articles were hand‐searched to identify relevant studies. After deduplication and screening, 11 clinical studies meet the criteria for detailed review. The selected clinical studies suggest that saw palmetto, caffeine, melatonin, marine extracts, rosemary oil, procyanidin, pumpkin seed oil, and cannabidiol oil might be considered in male AGA treatment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Natural products for male androgenetic alopecia

Gupta

Talukder

Bamimore

2022

Dermatologic Therapy

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“…Androgenetic alopecia (AGA) is the most common type of alopecia among men and women 1 . Pharmacologic treatments for AGA include oral finasteride and topical minoxidil 2,3 : both are approved by the Food and Drug Administration (FDA) as first‐line treatments for male AGA 1 – however, only the latter is FDA‐approved as a first‐line therapy for women with the condition. Low‐level laser (FDA approved) and platelet‐rich plasma (PRP) are among the recently used therapeutics for AGA 4,5 …”

Section: Introductionmentioning

confidence: 99%

“…4,5 While PRP is relatively new to the AGA literature, this agent is not a newcomer to medicine 6 ; for instance, PRP has been used as a therapeutic in hematology since the 1970s, 7 while topical minoxidil and oral finasteride became FDA approved to treat AGA after 1987. 2,3 Since the publication of Carlos Uebel's work in 2006, 5 the AGA literature has been flooded with studies on PRP's efficacy. [8][9][10][11][12][13][14][15][16][17][18] Uebel et al 19 were the first to demonstrate that AGA can be cosmetically improved with growth factors derived from platelets.…”

Section: Introductionmentioning

confidence: 99%

The effect of placebo in split‐scalp and whole‐head platelet‐rich plasma trials for androgenetic alopecia differs: Findings from a systematic review with quantitative evidence syntheses

Gupta

Bamimore

2022

J of Cosmetic Dermatology

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Background: Some studies have shown that platelet-rich plasma (PRP) improves androgenetic alopecia (AGA), while others do not. We determined whether the placebo effect significantly varies between split-scalp and whole-head trials on PRP monotherapy for AGA. Our rationale was based on the plausibility of PRP diffusing to the control (i.e., "placebo") side of split-scalp trials. This is not possible in whole-head studies. Methods:We systematically searched the literature for available data. Our choice of analyses and outcomes were determined by the available data.Results: Our endpoint was change in total hair density 6 months after baseline. Our regression showed that total hair density after 6 months was significantly (p < 0.05) higher in the placebo arm of split-scalp trials, compared to whole-head studies, by 37 hairs/cm 2 . Our one-arm meta-analyses showed that the pooled change in total hair density between the PRP side and placebo side in split-scalp studies was −3 hairs/ cm 2 (p = 0.37), that is, a slight decrease in hair density in the placebo side of the scalp.For whole-head studies, the corresponding difference in total hair density between patients receiving PRP and those on placebo was −30 hairs/cm 2 (p = 0.000017), that is, a much larger decrease in hair density. Patients in the placebo group in whole-head trials lost significantly more hair than in the placebo side of the split-head trials where hair loss was comparatively reduced -presumably because of PRP diffusing from the treatment side of the scalp. Conclusions:The association between design (i.e., split-scalp vs. whole-head) and outcome, in placebo arms of AGA trials on PRP monotherapy, had never been reported. This "design effect" could partly reconcile the incongruent conclusions across the PRP literature for AGA; furthermore, clinical guidelines can consider "design effect" when selecting evidence to base care practices on. K E Y W O R D S pattern baldness, placebo effect, platelet-rich plasma, regression analysis, split scalp | 1455 GUPTA And BAMIMORE How to cite this article: Gupta AK, Bamimore MA. The effect of placebo in split-scalp and whole-head rich plasma trials for androgenetic alopecia differs: Findings from a systematic review with quantitative evidence syntheses. J

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Relative Efficacy of Minoxidil and the 5-α Reductase Inhibitors in Androgenetic Alopecia Treatment of Male Patients

et al. 2022

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IMPORTANCEThere are knowledge gaps regarding the relative efficacy of 3 commonly used drugs for androgenetic alopecia (AGA), namely, minoxidil and the two 5-α reductase inhibitors dutasteride and finasteride.OBJECTIVE To examine the relative efficacy of any dose and administration route of minoxidil, dutasteride, and finasteride for the treatment of male AGA. DATA SOURCES Systematic searches were performed in PubMed on March 5, 2021, without date restrictions.STUDY SELECTION Eligible studies included those that investigated monotherapy with any dose and administration route of minoxidil, dutasteride, and finasteride.DATA EXTRACTION AND SYNTHESIS Data on the mean (SD) difference and sample size were used for the bayesian network meta-analyses. League tables and surface under the cumulative ranking curve values were used to examine the relative efficacy of the interventions. MAIN OUTCOMES AND MEASURESStudy end points were change in total and terminal hair count after 24 and 48 weeks of therapy. The 4 end points were quantified in hairs per square centimeters. RESULTSThe PubMed search yielded 848 records; after the 2 stages of screening, 23 studies were eligible for quantitative analyses. Mean (SD) age of patients ranged from 22.8 (3.3) years to 41.8 (12.3) years. The greatest increase in total hair count at 24 weeks (ie, first end point) was with 0.5 mg/d of dutasteride, which was significantly more efficacious than 1 mg/d of finasteride (mean difference, 7.1 hairs/cm 2 ; 95% CI, 5.1-9.3 hairs/cm 2 ) and minoxidil (0.25 mg/d [mean difference, 23.7 hairs/cm 2 ; 95% CI, 9.5-38.0 hairs/cm 2 ], 5 mg/d [mean difference, 15.0 hairs/cm 2 ; 95% CI, 3.9-26.1 hairs/cm 2 ], and 2% solution [mean difference, 8.5 hairs/cm 2 ; 95% CI, 4.8-12.3 hairs/cm 2 ]). The greatest increase in terminal hair count at 24 weeks (ie, second end point) was with 5 mg/d of minoxidil, which was significantly more efficacious than the 0.25-mg/d dose (mean difference, 43.6 hairs/cm 2 ; 95% CI, 29.7-57.7 hairs/cm 2 ) and its topical forms (in 2% [mean difference, 29.3 hairs/cm 2 ; 95% CI, 21.1-37.5 hairs/cm 2 ] and 5% [mean difference, 29.8 hairs/cm 2 ; 95% CI, 19.7-39.8 hairs/cm 2 ]); 5 mg/d of minoxidil was significantly more efficacious than 1 mg/d of finasteride (mean difference, 10.4 hairs/cm 2 ; 95% CI, 2.2-18.6 hairs/cm 2 ). The greatest increase in total hair count at 48 weeks (ie, third end point) was with 5 mg/d of finasteride, which was significantly more efficacious than 2% topical minoxidil (mean difference, 20.7 hairs/cm 2 ; 95% CI, 9.5-31.9 hairs/cm 2 ). The greatest increase in terminal hair count at 48 weeks (ie, fourth end point) was with 1 mg/d of finasteride, which was significantly more effective than topical minoxidil (in 2% [mean difference, 32.1 hairs/cm 2 ; 95% CI, 23.9-40.3 hairs/cm 2 ] and 5% [mean difference, 26.2 hairs/cm 2 ; 95% CI, 16.2-36.2 hairs/cm 2 ]). CONCLUSIONS AND RELEVANCEAs efficacy data from head-to-head trials accumulate, there could be a better sense of the relative efficacy of the different doses of the 5-...

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Minoxidil: a comprehensive review

Cited by 64 publications

References 99 publications

Natural products for male androgenetic alopecia

Natural products for male androgenetic alopecia

The effect of placebo in split‐scalp and whole‐head platelet‐rich plasma trials for androgenetic alopecia differs: Findings from a systematic review with quantitative evidence syntheses

Relative Efficacy of Minoxidil and the 5-α Reductase Inhibitors in Androgenetic Alopecia Treatment of Male Patients

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