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Frontiers in Medicine 2022Androgenetic alopecia (AGA) affects almost half the population, and several treatments intending to regenerate a normal scalp hair phenotype are used. This is the first...
BACKGROUND
Androgenetic alopecia (AGA) affects almost half the population, and several treatments intending to regenerate a normal scalp hair phenotype are used. This is the first study comparing treatment efficacy response and resistance using standardized continuous outcomes.
OBJECTIVE
To systematically compare the relative efficacy of treatments used for terminal hair (TH) regrowth in women and men with AGA.
METHODS
A systematic literature review was conducted (from inception to August 11, 2021) to identify randomized, Placebo-controlled trials with ≥ 20 patients and reporting changes in TH density after 24 weeks. Efficacy was analyzed by sex at 12 and 24 weeks using Bayesian network meta-analysis (B-NMA) and compared to frequentist and continuous outcomes profiles.
RESULTS
The search identified 2,314 unique articles. Ninety-eight were included for full-text review, and 17 articles met the inclusion criteria for data extraction and analyses. Eligible treatments included ALRV5XR, Dutasteride 0.5 mg/day, Finasteride 1 mg/day, low-level laser comb treatment (LLLT), Minoxidil 2% and 5%, Nutrafol, and Viviscal. At 24 weeks, the B-NMA regrowth efficacy in TH/cm and significance () in women were ALRV5XR: 30.09, LLLT: 16.62, Minoxidil 2%: 12.13, Minoxidil 5%: 10.82, and Nutrafol: 7.32, and in men; ALRV5XR: 21.03, LLLT: 18.75, Dutasteride: 18.37, Viviscal: 13.23, Minoxidil 5%: 13.13, Finasteride: 12.38, and Minoxidil 2%: 10.54. Two distinct TH regrowth response profiles were found; Continuous: ALRV5XR regrowth rates were linear in men and accelerated in women; Resistant: after 12 weeks, LLLT, Nutrafol, and Viviscal regrowth rates attenuated while Dutasteride and Finasteride plateaued; Minoxidil 2% and 5% lost some regrowth. There were no statistical differences for the same treatment between women and men. B-NMA provided more accurate, statistically relevant, and conservative results than the frequentist-NMA.
CONCLUSION
Some TH regrowth can be expected from most AGA treatments with less variability in women than men. Responses to drug treatments were rapid, showing strong early efficacy followed by the greatest resistance effects from flatlining to loss of regrowth after 12-16 weeks. Finasteride, Minoxidil 2% and Viviscal in men were not statistically different from Placebo. LLLT appeared more efficacious than pharmaceuticals. The natural product formulation ALRV5XR showed better efficacy in all tested parameters without signs of treatment resistance (see Graphical abstract).
SYSTEMATIC REVIEW REGISTRATION
www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021268040, identifier CRD42021268040.
PubMed: 36755885
DOI: 10.3389/fmed.2022.998623 -
Advanced Biomedical Research 2023(rosemary) is a common household plant with needle-like leaves and white flowers that belongs to the family Lamiaceae and has various medicinal properties including...
BACKGROUND
(rosemary) is a common household plant with needle-like leaves and white flowers that belongs to the family Lamiaceae and has various medicinal properties including ailments of hair and scalp, cardiovascular, nervous disorders, etc., In the current work, we have focused on formulation and evaluation of 1% hair lotion incorporated with methanolic extract of .
MATERIALS AND METHODS
The aerial parts of the plant were extracted with methanol and then the nature of phytochemicals were identified by chemical tests. It showed the presence of proteins, amino acids, fats and oils, steroids, glycosides, phenolic compounds, flavonoids, volatile oil, and vitamins. The extract was formulated to a suitable hair lotion and then evaluated for its various quality control parameters. Finally, the lotion was evaluated for hair growth promoting activity on C57BL/6 mice, using water as control and 2% minoxidil hair lotion as standard.
RESULTS
It was observed that the formulated 1% herbal hair lotion passed all the evaluation parameters and showed a significant hair growth promoting activity than the standard drug-treated animals.
CONCLUSION
Although several researches have been carried out on the rosemary, an investigation on formulation of hair lotion adding the extract of the aerial part of the plant is for the first time. Since our formulation exhibited an excellent activity, it can be well thought out to be an alternative to the commercially available hair growth promoters with a lot of unwanted effects.
PubMed: 37200757
DOI: 10.4103/abr.abr_306_21 -
Journal of Pharmacy & Pharmaceutical... 2021Prostaglandins play a pivotal role in modulating hair growth cycle. Prostaglandin F2α and prostaglandin E have stimulating and prostaglandin D has inhibitory effects on... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Prostaglandins play a pivotal role in modulating hair growth cycle. Prostaglandin F2α and prostaglandin E have stimulating and prostaglandin D has inhibitory effects on hair follicle. Cetirizine inhibits release of prostaglandin D2 and stimulates the release of prostaglandin E2. In the present study, the efficacy and safety of twice daily application of topical cetirizine 1% versus minoxidil 5% solutions for 16 weeks were compared in male androgenetic alopecia (AGA).
METHODS
Forty men, aged 18 to 49 years, were randomly divided into two equal groups to apply either cetirizine 1% or minoxidil 5% solutions. The study was divided into two phases, a 16-week treatment phase either with cetirizine or minoxidil (anagen phase), followed by an 8-week drug-free (telogen phase) with a follow-up when patients used placebo. Efficacy outcomes included the change in total hair density, vellus and terminal hair density, hair diameter and the percentage of hair in anagen and telogen phases from baseline in 16 and 24 weeks.
RESULTS
After 16 weeks, we observed a significant increase in total and vellus hair density in both minoxidil and cetirizine groups, but the improvement was much higher in the minoxidil group. The percentage of hair in the anagen phase also increased in both groups after 16 weeks of treatment, but then diminished after 8 weeks of placebo consumption. No significant adverse reactions associated with the administration of cetirizine solution were reported.
CONCLUSION
Cetirizine 1% solution was effective in hair growth without any complications for treatment of male AGA.
Topics: Administration, Topical; Adult; Alopecia; Cetirizine; Histamine Antagonists; Humans; Male; Minoxidil; Single-Blind Method; Solutions; Treatment Outcome; Young Adult
PubMed: 33909554
DOI: 10.18433/jpps31456 -
Journal of Clinical Hypertension... Sep 2011KEY POINTS AND PRACTICAL RECOMMENDATIONS: • Hydralazine and minoxidil act by dilating resistance arterioles, thus reducing peripheral resistance, with no dilating... (Review)
Review
KEY POINTS AND PRACTICAL RECOMMENDATIONS: • Hydralazine and minoxidil act by dilating resistance arterioles, thus reducing peripheral resistance, with no dilating effect on the venous side of the circulation. • There is a baroreflex-mediated venoconstriction, resulting in an increase in venous return to the heart, along with a direct catecholamine-mediated positive inotropic and chronotropic stimulation of the heart. • Hydralazine therapy is usually combined with a sympathetic inhibitor to prevent expression of this reflex, as well as with a diuretic agent to prevent sodium retention caused by reduction in renal perfusion pressure. • Hydralazine is indicated in the long-term therapy of essential hypertension, in the short-term therapy of pregnancy-induced hypertension and eclampsia, and in the therapy of hypertensive crisis. • Adverse effects include the anticipated tachycardia, fluid retention, and headache, caused by the vasodilation, especially in the early days of therapy, but may frequently be prevented by the concomitant use of a β-blocker. • As with other drugs that are N-acetylated, there is a low risk of lupus-like syndrome with high doses and long-term use. • Because of the severity of adverse effects with minoxidil, its usage is limited to persons with severe hypertension unresponsive to other treatments. • Hirsutism, a common side effect of minoxidil, is particularly bothersome in women and reverses in a few months after discontinuation. • Sodium nitroprusside is used in the intensive care setting to lower pressure in hypertensive crisis or to treat severe left ventricular failure, particularly valuable when elevated pressure or severe left ventricular failure threatens the patient's survival. • Although nitrates have not achieved widespread use as antihypertensive agents, they are effective in producing sustained blood pressure (BP) reductions when added to other antihypertensive regimens.
Topics: Antihypertensive Agents; Hirsutism; Humans; Hydralazine; Hypertension; Minoxidil; Tachycardia; Treatment Outcome; Vasodilator Agents
PubMed: 21896152
DOI: 10.1111/j.1751-7176.2011.00507.x -
Drug Design, Development and Therapy 2023To investigate the mechanism of minoxidil in treating androgenetic alopecia (AGA).
OBJECTIVE
To investigate the mechanism of minoxidil in treating androgenetic alopecia (AGA).
METHODS
The mechanism of action of minoxidil on AGA was first systematically investigated from the viewpoint of network pharmacology, including minoxidil-AGA target prediction, protein-protein interaction (PPI) network analysis, molecular docking and enrichment analysis of targets related to minoxidil and AGA, and dermal papilla cell assays to confirm the viability of prediction.
RESULTS
The combined analysis revealed that minoxidil treatment of AGA not only acts on androgenic receptors (AR) but also on 2 new targets, steroid 17-alpha-hydroxylase/17,20 lyase (CYP17A1) and aromatase (CYP19A1). The biological processes linked to these targets were concentrated on several pathways, including enzymes and hormones. Further experiments have revealed that minoxidil suppresses the expression of AR and CYP17A1, boosts the activity of CYP19A1, decreases the formation and binding of dihydrotestosterone, and enhances the production of estradiol. Through these changes, minoxidil acts as a treatment for AGA.
CONCLUSION
Minoxidil may act by altering hormonal and enzymatic pathways. Our study finds two new targets (CYP17A1, CYP19A1) of minoxidil and demonstrates that minoxidil inhibits AR. These targets may provide new ideas for drug research.
Topics: Humans; Minoxidil; Molecular Docking Simulation; Alopecia; Dietary Supplements; Estradiol
PubMed: 37645625
DOI: 10.2147/DDDT.S427612 -
Archives of Dermatological Research Jul 2023Androgenetic alopecia (AGA) is the most common cause of hair loss in both genders with a higher psychological impact on females. Currently, topical minoxidil is the only... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparison between topical cetirizine with minoxidil versus topical placebo with minoxidil in female androgenetic alopecia: a randomized, double-blind, placebo-controlled study.
Androgenetic alopecia (AGA) is the most common cause of hair loss in both genders with a higher psychological impact on females. Currently, topical minoxidil is the only FDA-approved treatment for female AGA and it needs life-long application and causes side effects. Cetirizine is an antihistamine that may be effective in hair loss treatment. This study aimed to compare the efficacy and safety of topical cetirizine with minoxidil (group 1) versus topical minoxidil with placebo (group 2) in female patients with AGA. This was a double-blind, randomized, controlled, parallel study conducted at Dermatology Clinic, Cairo University Teaching Hospital (Kasr- Al- Ainy), Egypt. Sixty-six patients with female AGA, aged 20-50 years, Sinclair (II-IV), were randomly assigned to one of the 2 groups for 24 weeks. The trichoscopic parameters, patients' self-assessment, side effects and global photographic assessment were evaluated. There was a statistically significant change from baseline in frontal and vertex terminal and vellus hair density (P < 0.0005) with a significant increase in vertex hair shaft thickness and average number of hairs per follicular unit in group 1 (P < 0.05). Patients reported significantly better scores in patient self-assessment in group 1 (P < 0.05). Side effects were not significantly different between groups (P > 0.05). Topical cetirizine increases hair shaft thickness and results in a higher clinical improvement from patients' perspective with a good safety profile (NCT04481412, study start date: July 2020).
Topics: Female; Humans; Male; Minoxidil; Cetirizine; Administration, Topical; Alopecia; Hair; Drug-Related Side Effects and Adverse Reactions
PubMed: 36571611
DOI: 10.1007/s00403-022-02512-2 -
International Journal of Trichology Jan 2013Dermal papilla (DP) is the site of expression of various hair growth related genes. Various researches have demonstrated the underlying importance of Wnt proteins and...
INTRODUCTION
Dermal papilla (DP) is the site of expression of various hair growth related genes. Various researches have demonstrated the underlying importance of Wnt proteins and wound growth factors in stimulating DP associated stem cells. Microneedling works by stimulation of stem cells and inducing activation of growth factors.
MATERIALS AND METHODS
Hundred cases of mild to moderate (III vertex or IV) androgenetic alopecia (AGA) were recruited into 2 groups. After randomization one group was offered weekly microneedling treatment with twice daily 5% minoxidil lotion (Microneedling group); other group was given only 5% minoxidil lotion. After baseline global photographs, the scalp were shaved off to ensure equal length of hair shaft in all. Hair count was done in 1 cm(2) targeted fixed area (marked with tattoo) at baseline and at end of therapy (week 12). The 3 primary efficacy parameters assessed were: Change from baseline hair count at 12 weeks, patient assessment of hair growth at 12 weeks, and investigator assessment of hair growth at 12 weeks. A blinded investigators evaluated global photographic response. The response was assessed by 7- point scale.
RESULTS
(1) Hair counts - The mean change in hair count at week 12 was significantly greater for the Microneedling group compared to the Minoxidil group (91.4 vs 22.2 respectively). (2) Investigator evaluation - Forty patients in Microneedling group had +2 to +3 response on 7-point visual analogue scale, while none showed the same response in the Minoxidil group. (3) Patient evaluation - In the Microneedling group, 41 (82%) patients reported more than 50% improvement versus only 2 (4.5%) patients in the Minoxidil group. Unsatisfied patients to conventional therapy for AGA got good response with Microneedling treatment.
CONCLUSION
Dermaroller along with Minoxidil treated group was statistically superior to Minoxidil treated group in promoting hair growth in men with AGA for all 3 primary efficacy measures of hair growth. Microneedling is a safe and a promising tool in hair stimulation and also is useful to treat hair loss refractory to Minoxidil therapy.
PubMed: 23960389
DOI: 10.4103/0974-7753.114700 -
Journal of the American Academy of... Mar 2021
Topics: Administration, Oral; Adult; Alopecia; Canada; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Male; Middle Aged; Minoxidil; Retrospective Studies; Treatment Outcome
PubMed: 33098962
DOI: 10.1016/j.jaad.2020.10.032 -
Indian Journal of Plastic Surgery :... Oct 2021Pattern hair loss (PHL) is a condition that worsens with time and the only way it can be slowed down is with pharmacological intervention. Pharmacological treatments for... (Review)
Review
Pattern hair loss (PHL) is a condition that worsens with time and the only way it can be slowed down is with pharmacological intervention. Pharmacological treatments for PHL, from an evidenced-based perspective with respect to safety and efficacy, are limited to only two drugs, minoxidil and finasteride. However, there are a host of drugs being used, off-label with limited evidence. This article attempts to review the literature on this topic, and the authors add to this, with their experience of over two decades on incorporating pharmacologic treatments along with hair transplantation in their management of PHL.
PubMed: 34984080
DOI: 10.1055/s-0041-1739254