Efficacy and Safety of Combinational Therapy Using Topical Minoxidil and Microneedling for the Treatment of Androgenetic Alopecia: A Systematic Review and Meta-Analysis

September 2023 in “ Archives of Dermatological Research ”

Parsa Abdi, Christian Awad, Michelle Anthony, Christopher Farkouh, Bret Kenny, Howard I. Maibach, Boluwaji Ogunyemi

topical minoxidil microneedling androgenetic alopecia hair count hair diameter adverse events scarring Rogaine

From the encyclopedia

Microneedling →

technique to create small wounds in skin to activate collagen production and hair growth

Minoxidil →

An essential vasodilator with some anti-androgenic effects

Studysummary Using minoxidil with microneedling increases hair count for hair loss without serious side effects. Our plain-language summary of this paper — not a Tressless recommendation.

A systematic review and meta-analysis of ten randomized controlled trials involving 466 patients found that combination therapy using topical minoxidil and microneedling significantly increased total hair count in patients with androgenetic alopecia compared to using minoxidil alone (SMD 1.76; 95% CI 1.26–2.26; P < 0.00001). However, there was no significant increase in hair diameter (SMD 0.82; 95% CI − 0.01 to 1.65; P = 0.05). No serious adverse events or scarring were reported. The study suggests that this multimodal therapeutic approach is effective, but notes that variations in factors like microneedling methods and treatment areas may have caused confounding. Further large-sample trials with rigorous methodologies are recommended for a more comprehensive understanding of treatment efficacy.

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Research cited in this study

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research Randomized Trial of Microneedling Combined With 2% Minoxidil Topical Solution for the Treatment of Female Pattern Hair Loss in a Chinese Population

1 citations , October 2022 in “Journal of Cosmetic Dermatology”

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research Does Topical Minoxidil at Concentrations Higher Than 5% Provide Additional Clinical Benefit?

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This review examines the efficacy and safety of using minoxidil at concentrations greater than 5% for androgenetic alopecia but reports no new clinical results, emphasizing a need for further research.

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2 citations , July 2022 in “Frontiers in Medicine”

This study found that combining topical minoxidil with microneedling improved hair density more than either minoxidil alone or with spironolactone for women with mild-to-moderate female pattern hair loss.

research Microneedling for Hair Loss

9 citations , October 2021 in “Journal of Cosmetic Dermatology”

This study found that microneedling monotherapy significantly increased hair count more than topical minoxidil in androgenetic alopecia, with combination therapy of microneedling and minoxidil being even more effective. Further research is needed to evaluate microneedling's safety and efficacy as a monotherapy.

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16 citations , June 2021 in “Journal of Dermatological Treatment”

This study reported that while topical minoxidil exhibits hair regrowth in androgenetic alopecia, oral minoxidil 5 mg/day was more effective than topical forms after six months, with low doses also potentially effective for women and other hair loss types.

research SULT1A1 (Minoxidil Sulfotransferase) Enzyme Booster Significantly Improves Response to Topical Minoxidil for Hair Regrowth

1 citations , June 2021 in “Journal of Cosmetic Dermatology”

In this study, the addition of a SULT1A1 enzyme booster to daily 5% minoxidil treatment significantly increased hair regrowth in men with androgenic alopecia compared to minoxidil alone.

research Combination Therapy with Topical Minoxidil and Nano-Microneedle-Assisted Fibroblast Growth Factor for Male Androgenetic Alopecia: A Randomized Controlled Trial in Chinese Patients

6 citations , November 2020 in “Chinese Medical Journal”

This study found that among Chinese males with male androgenic alopecia, combination therapy using topical minoxidil and nano-microneedle-assisted fibroblast growth factor significantly improved hair density, diameter, and follicular unit density over 16 weeks, outperforming individual treatments.

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research Sulfotransferase SULT1A1 Activity in Hair Follicle: A Prognostic Marker of Response to Minoxidil Treatment in Androgenetic Alopecia

November 2020 in “Postepy Dermatologii I Alergologii”

This review discusses the potential of using SULT1A1 expression in the scalp as a biomarker to predict response to minoxidil treatment for androgenetic alopecia, but reports no new clinical results.

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In this study, microneedling with a depth of 0.6 mm, alongside minoxidil, significantly improved hair count and thickness in patients with androgenetic alopecia compared to minoxidil alone, and was more beneficial than a 1.2 mm depth.

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research The Effectiveness of Combination Therapies for Androgenetic Alopecia: A Systematic Review and Meta-Analysis

11 citations , June 2020 in “Dermatologic Therapy”

This study suggests that combination therapies including minoxidil with either finasteride, low-level laser light therapy, or microneedling are more effective than minoxidil alone for treating androgenetic alopecia.

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research Randomized Trial of Electrodynamic Microneedling Combined with 5% Minoxidil Topical Solution for Treating Androgenetic Alopecia in Chinese Males and Molecular Mechanistic Study of the Involvement of the Wnt/β-Catenin Signaling Pathway

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This study found that combining microneedling with 5% minoxidil improved hair growth in Chinese men with androgenetic alopecia, possibly through activating the Wnt/β-catenin signaling pathway.

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research Sulfotransferase Activity in Plucked Hair Follicles Predicts Response to Topical Minoxidil Treatment in Brazilian Female Pattern Hair Loss Patients

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research Efficacy and Safety of a New 10% Topical Minoxidil Versus 5% Topical Minoxidil and Placebo in the Treatment of Male Androgenetic Alopecia: A Trichoscopic Evaluation

14 citations , August 2019 in “Journal of Dermatological Treatment”

This study found that 5% topical minoxidil was moderately more effective at increasing hair regrowth than 10% minoxidil and placebo in men with androgenetic alopecia.

research Minoxidil And Its Use In Hair Disorders: A Review

117 citations , August 2019 in “Drug Design Development and Therapy”

This review article provides an updated overview of the pharmacology, mechanism of action, clinical efficacy, and adverse events associated with topical minoxidil, a widely used treatment for androgenetic alopecia and other hair loss conditions, while noting that its exact mechanism is still not fully understood.

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research Evaluation of Long-Term Efficacy of Finasteride in Korean Men with Androgenetic Alopecia Using the Basic and Specific Classification System

11 citations , December 2018 in “Journal of Dermatology”

This study found that finasteride 1 mg improved hair growth in 85.7% of Korean men with androgenetic alopecia over five years, with varying effectiveness depending on the type of hair loss.

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research A Pilot Split-Scalp Study of Combined Fractional Radiofrequency Microneedling and 5% Topical Minoxidil in Treating Male Pattern Hair Loss

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This study found that combining fractional radiofrequency microneedling with 5% topical minoxidil improved hair count and thickness more than minoxidil alone in Chinese men with male pattern hair loss.

research A Randomized Controlled, Single-Observer Blinded Study to Determine the Efficacy of Topical Minoxidil Plus Microneedling Versus Topical Minoxidil Alone in the Treatment of Androgenetic Alopecia

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This study found that combining microneedling with topical minoxidil was more effective than minoxidil alone in increasing hair count and improving patient satisfaction for men with androgenetic alopecia, though the cosmetic impact was not significant.

research Review of Applications of Microneedling in Dermatology

108 citations , August 2017 in “Clinical, Cosmetic and Investigational Dermatology”

This review highlights microneedling's promise as an adjuvant therapy for enhanced drug delivery in dermatology, especially for conditions like atrophic scars and pigmentation disorders, though its efficacy for vitiligo is limited.

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This systematic review and meta-analysis found that minoxidil, finasteride, and low-level laser light therapy significantly improve hair growth in men with androgenetic alopecia, while minoxidil is also effective for women, compared to placebo.

research Minoxidil Dose Response Study in Female Pattern Hair Loss Patients Determined to Be Non-Responders to 5% Topical Minoxidil

4 citations , March 2017 in “PubMed”

This study found that a 15% topical minoxidil solution improved hair regrowth in 60% of women with female pattern hair loss who did not respond to the standard 5% solution, without adverse effects.

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research A Comparative Study of Microneedling with Platelet-Rich Plasma Plus Topical Minoxidil (5%) and Topical Minoxidil (5%) Alone in Androgenetic Alopecia

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research Micro-Needling Depth Penetration, Presence of Pigment Particles, and Fluorescein-Stained Platelets: Clinical Usage for Aesthetic Concerns

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research Demographics of Women with Female Pattern Hair Loss and the Effectiveness of Spironolactone Therapy

26 citations , September 2015 in “Journal of The American Academy of Dermatology”

In this study, spironolactone was reported to stabilize or improve female pattern hair loss in 74.3% of treated women, especially those with signs of hyperandrogenism.

Combined Treatment with Oral Finasteride and Topical Minoxidil in Male Androgenetic Alopecia: A Randomized and Comparative Study in Chinese Patients

research Combined Treatment with Oral Finasteride and Topical Minoxidil in Male Androgenetic Alopecia: A Randomized and Comparative Study in Chinese Patients

32 citations , June 2015 in “Dermatologic Therapy”

In this study, finasteride was found to be more effective than 5% minoxidil for treating male androgenetic alopecia in Chinese patients, with combination therapy showing the greatest improvement.

research Response to Microneedling Treatment in Men with Androgenetic Alopecia Who Failed to Respond to Conventional Therapy

68 citations , May 2015 in “Indian Journal of Dermatology”

This case series found that adding microneedling to conventional finasteride and minoxidil therapy for androgenetic alopecia improved new hair growth and patient satisfaction in poor responders.

research Cause of Androgenic Alopecia

17 citations , October 2013 in “Plastic and reconstructive surgery. Global open”

This review examines misconceptions and gaps in the understanding of androgenic alopecia (AGA) etiopathogenesis, offering new perspectives but no new experimental results.

research A Randomized Evaluator Blinded Study of Effect of Microneedling in Androgenetic Alopecia: A Pilot Study

136 citations , January 2013 in “International Journal of Trichology”

This study found that adding microneedling to minoxidil treatment significantly improved hair growth in men with androgenetic alopecia compared to minoxidil alone across all assessed measures.

research Male Androgenetic Alopecia: Population-Based Study in 1,005 Subjects

41 citations , January 2009 in “International Journal of Trichology”

This study found that 58% of men aged 30-50 had androgenic alopecia, with disease severity increasing with age and many being candidates for medical treatment or hair transplantation.

research An Open, Randomized, Comparative Study of Oral Finasteride and 5% Topical Minoxidil in Male Androgenetic Alopecia

71 citations , January 2004 in “Dermatology”

This study found that oral finasteride was more effective than 5% topical minoxidil in treating mild to severe androgenetic alopecia in males, with both treatments deemed effective and safe over 12 months.

A Randomized Clinical Trial of 5% Topical Minoxidil Versus 2% Topical Minoxidil and Placebo in the Treatment of Androgenetic Alopecia in Men

research A Randomized Clinical Trial of 5% Topical Minoxidil Versus 2% Topical Minoxidil and Placebo in the Treatment of Androgenetic Alopecia in Men

269 citations , August 2002 in “Journal of The American Academy of Dermatology”

This study found that 5% topical minoxidil significantly increased hair regrowth and improved psychosocial perceptions of hair loss in men with androgenetic alopecia compared to 2% topical minoxidil and placebo over 48 weeks.

research Hair Pain (Trichodynia): Frequency and Relationship to Hair Loss and Patient Gender

48 citations , January 2002 in “Dermatology”

In this study, hair pain (trichodynia) was reported by a significant portion of patients with hair loss, but it did not correlate with the cause or activity of the condition.