Clinical and Trichoscopic Evaluations of Topical Finasteride 1%, Topical Spironolactone 5%, and Minoxidil 5% in Female Pattern Hair Loss Treatment

January 2025 in “ Dermatology Practical & Conceptual ”

Naglaa Mohamed El Sayed, Eman H. Elmorsy, Tarek Hussein, Eman M. Hassan

finasteride spironolactone minoxidil female pattern hair loss hair density yellow dots single hair follicular units Propecia Rogaine FPHL

From the encyclopedia

Finasteride →

Frontline, gold standard treatment for combatting androgenic alopecia

Spironolactone →

powerful topical and oral anti-androgen used mostly by women

Minoxidil →

An essential vasodilator with some anti-androgenic effects

Studysummary This study found topical finasteride and minoxidil both improved hair loss clinically and trichoscopically more effectively than spironolactone in women with female pattern hair loss. Our plain-language summary of this paper — not a Tressless recommendation.

This study on 45 women with female pattern hair loss (FPHL) compared the efficacy and safety of topical finasteride 1%, spironolactone 5%, and minoxidil 5% over 16 weeks. Both finasteride and minoxidil demonstrated significant improvements in hair density and reduced signs of hair loss, such as yellow dots and single hair follicular units, while spironolactone did not show significant changes. The study concluded that topical finasteride is as effective and safe as minoxidil, providing an alternative for those who do not respond to or experience side effects from minoxidil.

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research Dermoscopic Evaluation of the Efficacy of Combination of Topical Spironolactone 5% and Minoxidil 5% Solutions in the Treatment of Androgenetic Alopecia: A Cross-Sectional Comparative Study

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

This study found that combining 5% topical minoxidil and 5% topical spironolactone solutions may enhance treatment efficacy for androgenetic alopecia in both men and women, with significant reductions in vellus hair.

research Topical Finasteride for Male and Female Pattern Hair Loss: Is It a Safe and Effective Alternative?

2 citations , March 2022 in “Journal of Cosmetic Dermatology”

This review found that topical finasteride has similar efficacy to oral finasteride in treating male and female pattern hair loss, with fewer systemic side effects, mainly causing localized scalp reactions like irritation and erythema.

research Development and Validation of a Dermoscopic Severity Score for Female Pattern Hair Loss

December 2021 in “Skin appendage disorders”

This study developed and validated an objective dermoscopic severity score for evaluating female pattern hair loss, which may serve as a supplementary outcome measure in therapeutic trials.

research Efficacy and Safety of Topical Finasteride Spray Solution for Male Androgenetic Alopecia: A Phase III, Randomized, Controlled Clinical Trial

11 citations , October 2021 in “Journal of The European Academy of Dermatology and Venereology”

This study found that topical finasteride significantly increased hair count in men with androgenetic alopecia compared to placebo while maintaining similar efficacy to oral finasteride but with lower systemic exposure and a reduced impact on serum DHT levels, potentially minimizing sexual side effects.

research Comparative Study of Efficacy of Topical Minoxidil Versus Topical Minoxidil With Finasteride in Androgenetic Alopecia

April 2021 in “International Journal of Research in Dermatology”

This study found that treating male pattern androgenetic alopecia with a combination of topical minoxidil and finasteride resulted in better outcomes for hair growth and density compared to using minoxidil alone.

A Novel Topical Combination of Minoxidil and Spironolactone for Androgenetic Alopecia: Clinical, Histopathological, and Physicochemical Study

research A Novel Topical Combination of Minoxidil and Spironolactone for Androgenetic Alopecia: Clinical, Histopathological, and Physicochemical Study

10 citations , December 2020 in “Dermatologic Therapy”

This study found that topical minoxidil 5% gel and spironolactone 1% gel were both effective treatments for androgenetic alopecia, with a combination of both providing the best clinical response and achieving 100% effectiveness among participants.

research Efficacy of Topical Finasteride 0.5% vs 17α-Estradiol 0.05% in the Treatment of Postmenopausal Female Pattern Hair Loss: A Retrospective, Single-Blind Study of 119 Patients

4 citations , April 2020 in “Dermatology practical & conceptual”

This study reported that among postmenopausal women with female pattern hair loss, treatment with topical finasteride 0.5% and minoxidil 2% was more effective at improving hair condition than treatment with topical 17α-estradiol 0.05% and minoxidil 2%, particularly notable at 12-18 months of follow-up.

research The Use of Trichoscopy to Assess the Efficacy of Topical Minoxidil 2% Solution in Patients with Female Pattern Hair Loss

September 2019 in “Zagazig university medical journal”

This study found that topical minoxidil 2% stimulated hair growth in women with female pattern hair loss after 4 months of treatment, though 55% reported side effects like dermatitis and hypertrichosis.

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

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 Dermoscopic Pre- And Post-Treatment Evaluation In Patients With Androgenetic Alopecia On Platelet-Rich Plasma—A Prospective Study

5 citations , December 2018 in “Journal of Cosmetic Dermatology”

This study found that after treatment with platelet-rich plasma, male androgenetic alopecia patients showed significant improvements in hair count, hair diversity, and reduction in certain dermoscopic features.

Characterization of Follicular Minoxidil Sulfotransferase Activity in a Cohort of Pattern Hair Loss Patients from the Indian Subcontinent

research Characterization of Follicular Minoxidil Sulfotransferase Activity in a Cohort of Pattern Hair Loss Patients from the Indian Subcontinent

8 citations , October 2018 in “Dermatologic Therapy”

In this study of Indian patients with pattern hair loss, 40.8% showed low sulfotransferase enzyme activity in hair follicles, with a higher prevalence of low activity in men compared to women.

Efficacy of Topical Combination of 0.25% Finasteride and 3% Minoxidil Versus 3% Minoxidil Solution in Female Pattern Hair Loss: A Randomized, Double-Blind, Controlled Study

research Efficacy of Topical Combination of 0.25% Finasteride and 3% Minoxidil Versus 3% Minoxidil Solution in Female Pattern Hair Loss: A Randomized, Double-Blind, Controlled Study

36 citations , September 2018 in “American Journal of Clinical Dermatology”

This study found that a topical combination of 0.25% finasteride and 3% minoxidil may increase hair diameter more effectively than 3% minoxidil alone in postmenopausal women with female pattern hair loss.

A Randomized, Double-Blind Controlled Study of the Efficacy and Safety of Topical Solution of 0.25% Finasteride Admixed with 3% Minoxidil vs. 3% Minoxidil Solution in the Treatment of Male Androgenetic Alopecia

research A Randomized, Double-Blind Controlled Study of the Efficacy and Safety of Topical Solution of 0.25% Finasteride Admixed with 3% Minoxidil vs. 3% Minoxidil Solution in the Treatment of Male Androgenetic Alopecia

43 citations , July 2018 in “Journal of The European Academy of Dermatology and Venereology”

This study found that a topical solution combining 0.25% finasteride with 3% minoxidil significantly improved hair growth, as measured by hair density, diameter, and global assessment, in men with androgenetic alopecia, compared to 3% minoxidil alone, over 24 weeks without systemic adverse effects reported.

research Female Pattern Hair Loss: A Clinical, Pathophysiologic, and Therapeutic Review

66 citations , June 2018 in “International Journal of Women's Dermatology”

This article discusses treatments for female pattern hair loss, highlighting that oral antiandrogens and topical minoxidil can effectively arrest progression and reverse miniaturization in many patients with mild-to-moderate cases, but it reports no new clinical results.

Low-Level Light and Minoxidil 5% Combination Versus Either Modality Alone in Management of Female Patterned Hair Loss: A Randomized Controlled Study

research Low-Level Light and Minoxidil 5% Combination Versus Either Modality Alone in Management of Female Patterned Hair Loss: A Randomized Controlled Study

34 citations , May 2017 in “Lasers in Surgery and Medicine”

This study found that combining low-level light therapy with topical minoxidil 5% may lead to better hair regrowth and patient satisfaction in treating female pattern hair loss compared to using each treatment alone.

research Relevance of Trichoscopy in the Differential Diagnosis of Alopecia: A Cross-Sectional Study from North India

38 citations , January 2016 in “Indian Journal of Dermatology, Venereology and Leprology”

This study found that trichoscopy was useful in diagnosing different types of alopecia, with specific trichoscopic features aiding in the differential diagnosis.

research Trichoscopic Findings of Androgenetic Alopecia and Their Association with Disease Severity

30 citations , March 2015 in “Journal of Dermatology”

This study found that certain trichoscopic features like white peripilar sign, yellow dots, and scalp pigmentation are positively correlated with the severity of androgenetic alopecia in Chinese patients.

research Scalp Dermatoscopic Findings in Androgenetic Alopecia and Their Relations with Disease Severity

30 citations , January 2014 in “Annals of Dermatology”

This study observed no significant relationship between trichoscopic findings and disease severity in male or female androgenetic alopecia, despite some specific patterns correlating with different severity levels in female patients.

research Serum Ferritin and Vitamin D in Female Hair Loss: Do They Play a Role?

62 citations , January 2013 in “Skin Pharmacology and Physiology”

This study found that low serum ferritin and vitamin D2 levels are associated with hair loss in females with chronic telogen effluvium and female pattern hair loss, suggesting potential benefits of screening and supplementation.

research Androgenetic Alopecia: An Update

88 citations , January 2013 in “Indian Journal of Dermatology, Venereology and Leprology”

This article reviews recent advancements in understanding and treating androgenetic alopecia, focusing on new genetic insights, stem cell roles, and diagnostic tools, without reporting new clinical results.

research Trichoscopy

42 citations , October 2012 in “Dermatologic Clinics”

This article reviews the use of trichoscopy for diagnosing common hair and scalp diseases and introduces a new classification for specific skin surface abnormalities, without presenting new clinical results.

research Dermoscopy Findings in Female Androgenetic Alopecia

12 citations , October 2012 in “Anais Brasileiros De Dermatologia”

This study found that dermoscopy is an effective tool for diagnosing and monitoring androgenetic alopecia in women, as it helped identify common signs such as hair miniaturization and peripilar brown halo.

research Female Pattern Hair Loss: Clinical and Laboratory Findings and Trichoscopy Depending on Disease Severity

28 citations , January 2012 in “International Journal of Trichology”

This study observed that specific trichoscopic features like white peripilar signs, scalp pigmentation, and focal atrichia are associated with advanced female pattern hair loss in Fitzpatrick skin type III patients.

research Clinical Evaluation of Alopecias Using a Handheld Dermatoscope

66 citations , November 2011 in “Journal of The American Academy of Dermatology”

This study concluded that a polarized-light handheld dermatoscope attached to a digital camera is a practical and useful tool for diagnosing different types of alopecia.

A Randomized, Single-Blind Trial of 5% Minoxidil Foam Once Daily Versus 2% Minoxidil Solution Twice Daily in the Treatment of Androgenetic Alopecia in Women

research A Randomized, Single-Blind Trial of 5% Minoxidil Foam Once Daily Versus 2% Minoxidil Solution Twice Daily in the Treatment of Androgenetic Alopecia in Women

100 citations , June 2011 in “Journal of The American Academy of Dermatology”

This study found that a once-daily 5% minoxidil topical foam is as effective as a twice-daily 2% minoxidil topical solution for hair growth in women with androgenetic alopecia, with fewer side effects and greater styling convenience.

research Scalp Dermoscopy of Androgenetic Alopecia in Asian People

67 citations , February 2009 in “Journal of Dermatology”

This study found that dermoscopy can be a useful tool for diagnosing androgenetic alopecia, particularly in determining hair diameter diversity as an essential feature in Asian populations.

research Dermoscopy in Female Androgenic Alopecia: Method Standardization and Diagnostic Criteria

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

This study found that trichoscopy criteria can distinguish female androgenic alopecia from chronic telogen effluvium, with specific features achieving 98% diagnostic specificity.

A Multicenter, Randomized, Placebo-Controlled, Double-Blind Clinical Trial of a Novel Formulation of 5% Minoxidil Topical Foam Versus Placebo in the Treatment of Androgenetic Alopecia in Men

research A Multicenter, Randomized, Placebo-Controlled, Double-Blind Clinical Trial of a Novel Formulation of 5% Minoxidil Topical Foam Versus Placebo in the Treatment of Androgenetic Alopecia in Men

142 citations , August 2007 in “Journal of The American Academy of Dermatology”

This study found that a new 5% minoxidil foam formulation significantly increased hair counts and improved hair loss condition in men with androgenetic alopecia over 16 weeks compared to placebo.

research Efficacy of 5% Minoxidil Versus Combined 5% Minoxidil and 0.01% Tretinoin for Male Pattern Hair Loss

43 citations , January 2007 in “American Journal of Clinical Dermatology”

This study concluded that a combined once-daily solution of 5% minoxidil and 0.01% tretinoin is as effective and safe as the conventional twice-daily 5% minoxidil application for treating androgenetic alopecia in men.

research Videodermoscopy in the Evaluation of Hair and Scalp Disorders

304 citations , July 2006 in “Journal of The American Academy of Dermatology”

This study found that videodermoscopy enhances diagnostic accuracy for scalp and hair disorders beyond simple clinical inspection and reveals novel disease features that could improve clinical understanding.

research The Histopathology of Noncicatricial Alopecia

43 citations , March 2006 in “Seminars in Cutaneous Medicine and Surgery”

This review examines the histopathologic features of four common types of noncicatricial alopecia and reports no new clinical results.

Novel and Established Potassium Channel Openers Stimulate Hair Growth In Vitro: Implications for Their Modes of Action in Hair Follicles

research Novel and Established Potassium Channel Openers Stimulate Hair Growth In Vitro: Implications for Their Modes of Action in Hair Follicles

35 citations , March 2005 in “Journal of Investigative Dermatology”

In this in vitro study, minoxidil, diazoxide, and the novel compound NNC 55-0118 increased hair follicle growth, supporting deer follicles as a viable bioassay for ATP-sensitive potassium channel modulators.

research A Randomized, Placebo-Controlled Trial of 5% and 2% Topical Minoxidil Solutions in the Treatment of Female Pattern Hair Loss

219 citations , March 2004 in “Journal of The American Academy of Dermatology”

In this 48-week trial, 5% topical minoxidil was more effective than both 2% minoxidil and placebo in promoting hair growth in women with female pattern hair loss, with notable improvements in nonvellus hair count and hair growth assessments.

research Histological Features of Peripilar Signs Associated with Androgenetic Alopecia

95 citations , January 2004 in “Archives of Dermatological Research”

This study found that peripilar signs on the scalp are linked to perifollicular lymphocytic infiltrates in early androgenetic alopecia, detectable even in areas with high hair density.

research Topical Finasteride in the Treatment of Androgenic Alopecia: Preliminary Evaluations After a 16-Month Therapy Course

30 citations , January 1997 in “Journal of Dermatological Treatment”

This study reported that a 0.005% finasteride solution may encourage hair regrowth and reduce balding areas in patients with androgenic alopecia, without significant absorption or adverse effects.