Comparing Hair Loss Treatments That Actually Work: What the Data Shows

Introduction

Understanding the various treatment options is critical for anyone battling the distressing challenges of hair thinning. Androgenic alopecia, often known as pattern hair loss, is a complicated biological condition impacted by both environmental and genetic conditions. People who are interested in treating hair loss can make well-informed judgments by learning about the scientific concepts underlying these treatments. Let's dive into the different treatments and what the scientific research says about each one's efficacy in treating alopecia.

Pharmaceutical Hair Loss Treatments

The most common pharmaceutical hair loss treatments include Minoxidil (Rogaine), Finasteride (Propecia) and Dutasteride (Avodart). Cosmetic treatments like microneedling have also emerged as an effective therapeutic option for people suffering from alopecia.

1. Minoxidil

Minoxidil is a vasodilatory agent that tends to enhance circulation to the hair follicles thus boosting hair growth. Rogaine is the most common brand available on the market. Its topical solutions and spray are most commonly used dosage forms. It is available in the 2, 5 and 10% strengthwith a twice daily dose (1-2 mL) for 6 months. The regimen is usually continued based on the individual’s response to sustain therapy (Suchonwanit et al., 2019).

2. Finasteride

Finasteride is a 5 alpha-reductase inhibitor. It prevents the conversion of testosterone into DHT and prevents the loss of hair. It is available in topical solutions and oral tablets. The marketed brand is Propecia in 1mg tablet form. The required dose for androgenic alopecia in adults is once daily . The regimen is usually continued based on the individual’s response to sustain therapy. (Libecco and Bergfeld, 2004).

3. Dutasteride

Dutasteride is another 5 alpha-reductase inhibitor. It functions by inhibiting the 5 alpha reductase enzyme and preventing the conversion into DHT. This decreases hair loss in people suffering from alopecia. Avodart is the marketed brand available. It is only FDA-approved to treat enlarged prostate but has been used as an effectiveoff-label medication for hair loss. It is available in the form of capsules with a strength of 0.5 mg.(Arif et al., 2017).

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4. Microneedling

Microneedling is a less invasive dermatological procedure that involves rolling tiny needles over the skin to puncture the stratum corneum. The purpose of this therapy is to stimulate the creation of growth factors and collagen in the treated areas. It has been effectively used with other hair growth-promoting therapies, such as minoxidil, platelet-rich plasma, and topical steroids, and has been demonstrated to stimulate hair follicular growth. One way that microneedling is believed to encourage hair growth is by making such first-line drugs easier to penetrate (Fertig et al., 2018).

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Evaluating the Data: Comparative Analysis based on Efficacy and Side Effects

A study conducted in 2001 assessed the efficacy and side effects of Minoxidil in 24 patients. A 2% minoxidil solution was applied daily for one year and patients were assessed every 3 months. The group showed a mean score of improvement in hair fall equivalent to 1.25 (mild). The assessment was based on a 5-point physician’s scale with outcomes ranging from zero, mild, moderate, significant and drastic improvement. Mild improvement in hair growth was achieved after a year. No local side effects were observed based on its topical application (Khandpur et al., 2002).

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The same study assessed the efficacy and side effects of Finasteride in 30 patients. 1mg oral Finasteride was given daily for one year and patient assessment was done every 3 months. The group showed a mean score of improvement in hair fall equivalent to 2. Moderate improvement in hair growth was achieved after a year. Loss of libido was observed in 1.32% of subjects after 3 months of finasteride administration. Overall, the average range observed for the incidence was 1–4.2% in other studies conducted. The average age of subjects for this study was 24-25 years. Other than that, no other side effects were observed (Khandpur et al., 2002).

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A 2022 study assessed the efficacy of Dutasteride in comparison to other pharmaceutical treatments. Dutasteride was administered at a dose equivalent to 0.5 mg for one year. Total hair counts were assessed after 24 and 48 weeks. 0.5 mg oral dutasteride was found to be most efficacious (96% increase in hair count) in comparison to oral finasteride (88% increase) and topical Minoxidil (80% increase) after 24 weeks based on total hair count change (Gupta et al., 2022). Another study was conducted to assess the side effects of 0.5 mg dutasteride. The assessment was done every 3,6 and 10 months of the treatment. Drug-based side effects occurred in 6.9% of the subjects. The most prevalent drug-related side effects were sexual dysfunctions (Eun et al., 2010). The side effects are minimal but occur frequently over prolonged use. This shows that it may lead to decreased patient compliance if the treatment course is taken over a long period. This problem is reported by patients who use 5 alpha-reductase inhibitors, which has given rise to the switching of dosage forms from oral to topical to avoid systemic effects.

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A 2013 study assessed the efficacy of microneedling by recruiting two groups. One group received a pharmaceutical treatment (minoxidil) and the other received microneedling and minoxidil. Hair counts were assessed to determine efficacy. When comparing the microneedling group to the Minoxidil group, the mean change in hair count at week 12 was much higher (91.4 vs. 22.2, respectively). Moreover, Only 2 (4.5%) patients in the minoxidil group reported more than 50% improvement, compared to 41 (82%) individuals in the microneedling group (Dhurat et al., 2013). The side effects of the procedure were assessed based on a systematic review. Transitory procedural effects, such as transient erythema/edema and discomfort, postinflammatory hyperpigmentation (PIH), dry skin, lymphadenopathy, and irritating contact dermatitis, are anticipated to last up to seven days after the treatment. Granulomatous responses, tram-track scarring, and PIH were among the long-lasting, severe side effects (Chu et al., 2021). The significance of these side effects is mainly targeted towards patient compliance in the long run. If the patient compromises on the therapeutic regimen, ultimately the efficacy of the drug is compromised leading to failure of required results. All these side effects are topical based and can be managed so it enables this particular treatment better than oral treatments for alopecia i.e. no significant systemic effects.
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Conclusion

The selection of an optimal treatment option depends on both the efficacy, side effects and patient compliance. From the above data, we can see dutasteride as the most promising pharmaceutical option to treat alopecia. It offers the highest efficacy at the lowest dose (high potency). But if we weigh the side effects as well then the dynamic may shift. Microneedling serves as an emerging procedure to boost the functioning of these medications. This may lead to a substantial increase in hair growth as reported by the study above. The comparison of these treatments shows the diversity of available options, each with its unique advantages and considerations. This allows for further exploration regarding the treatments for alopecia.

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References

ARIF, T., DORJAY, K., ADIL, M. & SAMI, M. 2017. Dutasteride in androgenetic alopecia: an update. Current Clinical Pharmacology, 12, 31-35.

CHU, S., FOULAD, D. P. & MESINKOVSKA, N. A. 2021. Safety profile for microneedling: a systematic review. Dermatologic Surgery, 47, 1249-1254.

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DHURAT, R., SUKESH, M., AVHAD, G., DANDALE, A., PAL, A. & PUND, P. 2013. A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study. International journal of trichology, 5, 6.

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EUN, H. C., KWON, O. S., YEON, J. H., SHIN, H. S., KIM, B. Y., RO, B. I., CHO, H. K., SIM, W. Y., LEW, B. L. & LEE, W.-S. 2010. Efficacy, safety, and tolerability of dutasteride 0.5 mg once daily in male patients with male pattern hair loss: a randomized, double-blind, placebo-controlled, phase III study. Journal of the American Academy of Dermatology, 63, 252-258.

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FERTIG, R., GAMRET, A., CERVANTES, J. & TOSTI, A. 2018. Microneedling for the treatment of hair loss? Journal of the European Academy of Dermatology and Venereology, 32, 564-569.

GUPTA, A. K., VENKATARAMAN, M., TALUKDER, M. & BAMIMORE, M. A. 2022. Relative efficacy of minoxidil and the 5-α reductase inhibitors in androgenetic alopecia treatment of male patients: a network meta-analysis. JAMA dermatology, 158, 266-274.

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KHANDPUR, S., SUMAN, M. & REDDY, B. S. 2002. Comparative efficacy of various treatment regimens for androgenetic alopecia in men. The Journal of dermatology, 29, 489-498.

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LIBECCO, J. F. & BERGFELD, W. F. 2004. Finasteride in the treatment of alopecia. Expert Opinion on Pharmacotherapy, 5, 933-940.

SUCHONWANIT, P., THAMMARUCHA, S. & LEERUNYAKUL, K. 2019. Minoxidil and its use in hair disorders: a review. Drug design, development and therapy, 2777-2786.