Trichogenic effect of topical ketoconazole versus minoxidil 2% in female pattern hair loss: a clinical and trichoscopic evaluation

Abstract

Background Female pattern hair loss (FPHL) is a common non-scaring alopecia. Topical minoxidil is the only approved treatment for FPHL; however, it has frequent side effects. Ketoconazole is an antifungal with anti-androgenic properties. Methods The aim of this work was to evaluate the safety and possible trichogenic effects of ketoconazole in FPHL. Patients were randomly assigned into Group A with 20 patients who received 2% topical minoxidil solution and Group B involving 20 patients who were treated by 2% topical ketoconazole preparation. All patients were treated for 6 months and evaluated clinically plus via trichoscopy. Side effects were recorded, and patients’ satisfaction was measured. Results Regarding hair growth, a significant difference was detected between baseline and at 4th and 6th months in Group A. While in Group B, the improvement was delayed until the 6th month. Only 10% of Group B reported side effects. Patients’ satisfaction did not differ between the two groups. Conclusions Topical ketoconazole mediates a trichogenic effect in FPHL with few side effects. However, ketoconazole showed a delayed improvement versus minoxidil at similar concentrations. Further studies should evaluate the efficacy of higher concentrations of ketoconazole solutions for FPHL which is a promising therapy. Trial registration IRB approval status: reviewed and approved by IRB of Faculty of Medicine, Zagazig University; approval no. #3642

Integrative and Mechanistic Approach to the Hair Growth Cycle and Hair Loss

“…Whereas a significant difference between baseline and months 4 and 6 was observed among those receiving topical minoxidil, significant improvement with ketoconazole was observed only at month 6, suggesting delayed treatment efficacy with ketoconazole. However, whereas treatment-related side effects were reported among 55% of those receiving minoxidil, side effects were reported in only 10% receiving ketoconazole, and there was no difference in patient satisfaction between the groups [42]. These studies highlight the potential therapeutic role of cortisol inhibition on hair regrowth in patients with both male and female-pattern androgenetic alopecia, although additional large, randomized controlled trials are needed to better assess efficacy.…”

“…Lastly, a 2019 study compared the efficacy of 2% topical ketoconazole in comparison to 2% minoxidil among patients with FPAnA [42]. Whereas a significant difference between baseline and months 4 and 6 was observed among those receiving topical minoxidil, significant improvement with ketoconazole was observed only at month 6, suggesting delayed treatment efficacy with ketoconazole.…”

Prospective, Open-Label, Multi-Centre, Randomized Study to Compare the Effectiveness, Safety, and Tolerability of Lulican™ Shampoo Versus Ketoconazole Shampoo in Indian Adult Patients With Mild to Moderate Scalp Seborrheic Dermatitis (LEAD Study)

“…Kubicki et al reported a case of non-scarring hair loss secondary to androgenic alopecia who developed pink discolouration of the hair with 2% ketoconazole shampoo [ 22 ]. Another study by Ahmed et al found that ketoconazole shampoo was associated with contact dermatitis in 10% of the study participants [ 23 ]. However, luliconazole’s lack of serious adverse effects is encouraging.…”

Androgenetic alopecia updates: Pathophysiology, diagnosis and treatment

“…Two controlled trials have shown that the topical administration of a 0.1% melatonin solution greatly promotes the growth phase of hair (known as anagen) in both male and female individuals with AGA. Furthermore, this treatment has been found to be well-tolerated by the participants [49] .…”