Drug therapy to combat hair loss, a major concern for both men and women, consists of two very different drugs — one an oral drug called finasteride and the other a topical medication is known as minoxidil.
While finasteride has been widely acclaimed as the treatment of choice for hair loss, a simple tool used in connection with applications of minoxidil to the scalp could significantly improve minoxidil’s effectiveness.
Finasteride, approved in 1997 by the Food and Drug Administration for use in men only and also sold under the brand name Propecia, works by inhibiting an enzyme that converts testosterone into an androgen known as dihydrotestosterone, or DHT. The DHT enzyme shrinks hair follicles until they can no longer support hair growth, thus leading to the most common form of hair loss, androgenetic alopecia, also known as male-pattern hair loss, although the same process causes hair loss in women.
Minoxidil Stimulates Blood Flow
Minoxidil, originally introduced as a prescription hair loss drug under the brand name Rogaine in the late 1980s, reinvigorates shrunken hair follicles by directing robust blood flow to those follicles. Although it was originally approved for use in men only, it has since been marketed for both men and women. Because it is a topical medication, it is applied to areas of hair loss on the scalp.
The American Hair Loss Association, based in Calabasas, California, is a large consumer organization dedicated to informing the public and healthcare professionals about hair loss and how it can best be treated. The organization considers finasteride the most effective drug against hair loss in men because the drug works at the hormonal level and has been clinically proven to slow the progression of hair loss. However, the AHLA still recommends minoxidil for men who have not responded to treatment with finasteride or those who would like to add another form of therapy to their regimen of hair loss treatment.
Combining Minoxidil with Microneedling
Research in recent years has revealed that combining the topical application of minoxidil with a technique called microneedling has helped to maximize the drug’s effects in men suffering from androgenetic alopecia. One of the earlier studies, published in the January-March 2013 issue of the “International Journal of Trichology,” recruited a large number of men between the ages of 20 and 35 who were suffering from mild to moderate androgenetic alopecia.
The research team, made up of dermatologists from India’s L.T.M. Medical College and General Hospital in Mumbai, randomly divided the 100 study participants into two groups. The first group received a microneedling treatment of the scalp once a week along with twice-daily topical applications of 5 percent minoxidil solution. The second group received only the twice-daily applications of minoxidil in the same strength as the microneedling group.
All Hair Shaved Off Before Study
To ensure that all study participants had an equal length of hair shaft at the start of the 12-week study period, the scalps of all study participants were shaved. In addition to their twice-daily applications of minoxidil, those in the microneedling group were subjected to weekly scalp treatments with a dermaroller with hundreds of tiny needles roughly 1.5 millimeters in length. All patients in the microneedling group received local anesthetic before the dermaroller treatment was begun, and their scalps were topically treated with Betadine and saline solutions.
The dermaroller was rolled over affected areas of the scalp in diagonal, longitudinal, and vertical directions until all affected areas showed signs of superficial reddening, indicating the treatment had successfully dilated capillaries just below the skin surface. Test subjects in the microneedling group were then told to wait 24 hours before beginning their twice-daily topical applications of minoxidil to the scalp.
How Hair Growth Was Assessed
In the meantime, those in the minoxidil-only test group received twice-daily applications of the drug to the scalp. At the conclusion of the 12-week period, hair growth in affected areas was assessed on the basis of three parameters: (1) change from baseline hair growth, (2) patient assessment of hair growth, and (3) investigator assessment of hair growth.
Of the 100 study participants who began the 12-week hair regrowth trial, 94 successfully completed the program. Those included all 50 in the microneedling group and 44 in the minoxidil-only group. The mean change in hair growth from baseline to the end of the study was significantly higher in the microneedling group.
Microneedling Outperformed Minoxidil Alone
Eighty-two percent of those in the microneedling group reported more than 50 percent improvement in hair growth, while only 4.5 percent in the minoxidil-only group reported similar improvement. Investigators noted hair growth improvement of 26 to 75 percent in 40 of the 50 test subjects in the microneedling group and in none of the patients in the minoxidil-only group.
The basic premise underlying the Indian study on the effects of microneedling was that the dermal papilla, located just below the hair follicles, was “the site of expression of various hair growth-related genes.” Researchers theorized that minor injury to the dermal papilla would stimulate blood flow to hair follicles and also trigger increased activity by stem cells.
Enhancing Technique with Platelet-Rich Plasma
A more recent study by Indian researchers compared the effects of minoxidil-only treatment versus microneedling followed up by injections of platelet-rich plasma and topical applications of minoxidil. The research team published its findings in the January-March 2017 issue of the “International Journal of Trichology,” the official journal of the Hair Research Society of India.
The researchers recruited 50 patients diagnosed with varying degrees of hair loss caused by androgenetic alopecia. Study participants were randomly divided into two groups of 25 each. The first group was treated twice daily with topical applications 1 milliliter of 5 percent minoxidil to affected areas of the scalp. The second group got topical minoxidil treatment as well as monthly microneedling treatments that were followed with injections of platelet-rich plasma, or PRP, into affected areas. PRP is a concentration of the patient’s own platelets and will speed healing.
Study Results Were Encouraging
At the conclusion of the six-month study, both researchers and participants alike found significantly greater hair growth among those receiving the combination treatment of minoxidil plus microneedling and PRP, compared with those in the minoxidil-only group.
An overview of the microneedling technique at TopHairLossTreatments.com characterizes this form of therapy as “a painful but effective hair loss treatment.” The article says that studies have suggested that the procedure triggers three key mechanisms of action:
- The release of both platelet-derived growth factor and epidermal growth factors increases platelet activation and stimulates the skin wound regeneration mechanism.
- The healing of minor wounds caused by the dermaroller activates stem cells in the hair bulge area and thus stimulates hair growth and slows hair loss.
- Overexpression of hair growth-related genes stimulates blood flow to hair follicles, thus reinvigorating them and promoting hair growth.
Evidence Still Fairly Limited
While somewhat less enthusiastic about the hair growth potential of the microneedling procedure, a recent review of data from previous studies nevertheless sounded some hopeful notes about the technique.
This review was conducted by dermatologic researchers associated with the University of Miami Miller School of Medicine and was published in the December 1, 2017, issue of the “Journal of the European Academy of Dermatology and Venereology.”
Acknowledging that the number of studies of microneedling’s effects in fighting hair loss is limited thus far, the review says the current evidence is insufficient to claim microneedling is superior to existing standard therapies for hair loss. However, it noted that “microneedling shows some promise in improving hair growth, especially in combination with existing techniques.”
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