Effectiveness and safety of the combination therapy of micro-needling and minoxidil in androgenetic alopecia of Indonesian men: a randomized controlled trial

Kara Adistri; Sondang P. Sirait; Rahadi Rihatmadja; Lili Legiawati; Wresti Indriatmi; Siti R.F. Saldi

doi:10.4081/dr.2024.9945

Androgenetic alopecia (AGA) is the most common type of hair loss. Treatment options are limited. Microneedling, a minimally invasive technique can enhance hair growth by releasing growth factors. However, no standardized protocol for frequency, depth and duration is available. This study aimed to determine the effectiveness and safety of the combination therapy of microneedling and minoxidil in AGA. This study was a randomized controlled clinical trial conducted over 12 weeks. The intervention group received a 4-weekly combination therapy of microneedling + 5% minoxidil, while the control group got only topical 5% minoxidil. Hair density and diameter were assessed using FotoFinder^® trichoscale (Fotofinder Systems GmBH, Bad Birnbach, Germany) every 4 weeks. A total of 36 male participants, between 26-51 years old, with Hamilton-Norwood type IIIVI AGA were included. At the end of the study, the intervention group had significantly higher hair density (95.6 vs 52.4 hair/cm², p<0.001) and diameter (18 vs 6 μm, p=0.004) than the control group. Side effects, included itching and transient erythema, were well tolerated. The combination of 4-weekly microneedling and topical 5% minoxidil is effective in increasing both hair density and hair diameter, and safe to use in AGA patients.

Blume-Peytavi U, Kanti V. Androgenetic alopecia. In: Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ, et al., editors. Fitzpatrick's dermatology. 9th edition. New York: McGraw-Hill Company; 2019. p. 1495-506.

He F, Shen M, Zhao Z, et al. Epidemiology and disease burden of androgenetic alopecia in college freshmen in China: A population-based study. PLoS One. 2022;17:e0263912. DOI: https://doi.org/10.1371/journal.pone.0263912

Wang TL, Zhou C, Shen YW, et al. Prevalence of androgenetic alopecia in China: a community-based study in six cities. Br J Dermatol. 2010 ;162:843-7. DOI: https://doi.org/10.1111/j.1365-2133.2010.09640.x

Legiawati L, Suseno LS, Sitohang IBS, Pratama AI. Hair disorder in dr. Cipto Mangunkusumo cosmetic dermatology and venereology outpatient clinic of Jakarta, Indonesia: A socio-demographic and clinical evaluation. Dermatol Reports. 2022;14:9341. DOI: https://doi.org/10.4081/dr.2022.9341

Lee WS, Lee HJ. Characteristics of androgenetic alopecia in asian. Ann Dermatol. 2012;24:243-52. DOI: https://doi.org/10.5021/ad.2012.24.3.243

Lolli F, Pallotti F, Rossi A, et al. Androgenetic alopecia: a review. Endocrine. 2017;57:9-17. DOI: https://doi.org/10.1007/s12020-017-1280-y

Nasution K, Pradigo R, Chandra R. The type of androgenetic alopecia and quality of life (QoL) in male patients. J Med Sci. 2022;54:40-50. DOI: https://doi.org/10.19106/JMedSci005401202205

Yamazaki M, Miyakura T, Uchiyama M, et al. Oral finasteride improved the quality of life of androgenetic alopecia patients. J Dermatol. 2011;38:773-7. DOI: https://doi.org/10.1111/j.1346-8138.2010.01126.x

Kelly Y, Blanco A, Tosti A. Androgenetic alopecia: an update of treatment options. Drugs. 2016;76:1349-64. DOI: https://doi.org/10.1007/s40265-016-0629-5

Ocampo-Garza SS, Fabbrocini G, Ocampo-Candiani J, Cinelli E, Villani A. Micro needling: a novel therapeutic approach for androgenetic alopecia, a review of literature. Dermatol Ther. 2020;33:e14267. DOI: https://doi.org/10.1111/dth.14267

Xu F, Sheng YY, Mu ZL, et al. Prevalence and types of androgenetic alopecia in Shanghai, China: a community-based study. Br J Dermatol. 2009;160:629-32. DOI: https://doi.org/10.1111/j.1365-2133.2008.08909.x

Sehgal VN, Kak R, Aggarwal A, Srivastava G, Rajput P. Male pattern androgenetic alopecia in an Indian context: a perspective study. J Eur Acad Dermatol Venereol. 2007;21:473-9. DOI: https://doi.org/10.1111/j.1468-3083.2006.01920.x

Kumar MK, Inamadar AC, Palit A. 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. J Cutan Aesthet Surg. 2018;11:211-6. DOI: https://doi.org/10.4103/JCAS.JCAS_130_17

Sohng C, Lee EH, Woo SK, et al. Usefulness of home-use microneedle devices in the treatment of pattern hair loss. J Cosmet Dermatol. 2021;20:591-6. DOI: https://doi.org/10.1111/jocd.13540

Bao L, Gong L, Guo M, et al. Randomized trial of electrodynamic microneedle combined with 5% minoxidil topical solution for the treatment of Chinese male Androgenetic alopecia. J Cosmet Laser Ther 2020;22:1-7. DOI: https://doi.org/10.1080/14764172.2017.1376094

Faghihi G, Nabavinejad S, Mokhtari F, Fatemi Naeini F, Iraji F. Microneedling in androgenetic alopecia; comparing two different depths of microneedles. J Cosmet Dermatol. 2021;20:1241-7. DOI: https://doi.org/10.1111/jocd.13714

Bao L, Zong H, Fang S, Zheng L, Li Y. 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/beta-catenin signaling pathway. J Dermatolog Treat. 2022;33:483-93. DOI: https://doi.org/10.1080/09546634.2020.1770162

Premanand A, Reena Rajkumari B. Androgen modulation of Wnt/beta-catenin signaling in androgenetic alopecia. Arch Dermatol Res. 2018;310:391-9. DOI: https://doi.org/10.1007/s00403-018-1826-8

Rakowska A. Trichoscopy (hair and scalp videodermoscopy) in the healthy female. Method standardization and norms for measurable parameters. J Dermatol Case Rep. 2009;3:14-9. DOI: https://doi.org/10.3315/jdcr.2008.1021

Cohen BE, Elbuluk N. Microneedling in skin of color: a review of uses and efficacy. J Am Acad Dermatol. 2016;74:348-55. DOI: https://doi.org/10.1016/j.jaad.2015.09.024

Singh A, Yadav S. Microneedling: advances and widening horizons. Indian Dermatol Online J. 2016;7:244-54. DOI: https://doi.org/10.4103/2229-5178.185468

Bonati LM, Epstein GK, Strugar TL. Microneedling in all skin types: a review. J Drugs Dermatol. 2017;16:308-13.

Supporting Agencies

Universitas Indonesia

Adistri, K., Sirait, S. P., Rihatmadja, R., Legiawati, L., Indriatmi, W., & Saldi, S. R. (2024). Effectiveness and safety of the combination therapy of micro-needling and minoxidil in androgenetic alopecia of Indonesian men: a randomized controlled trial. Dermatology Reports, 16(3). https://doi.org/10.4081/dr.2024.9945