Advertisement

Efficacy of Off-Label Topical Treatments for the Management of Androgenetic Alopecia: A Review

  • Aditya K. GuptaEmail author
  • Rachel R. Mays
  • Sarah G. Versteeg
  • Neil H. Shear
  • Vincent Piguet
  • Bianca Maria Piraccini
Review Article

Abstract

Androgenetic alopecia (AGA) is characterized by non-scarring follicle miniaturization. Despite the success of approved therapies, commonly reported side effects and the need for continual use has led to the investigation of alternative therapies. The aim of this paper is to critically review the success of off-label, topical monotherapies for treatment of AGA in men. A literature search was conducted to obtain randomized, controlled and blinded studies that investigated off-label, topical, monotherapies in male patients. Hair density, hair diameter and hair growth were used to evaluate treatment success. Fourteen off-label topical therapies were investigated among the 16 studies that met inclusion criteria. Nine off-label therapies were reported to produce a significantly greater improvement in hair restoration parameters (e.g. mean change from hair count and hair diameter) as compared to placebo (p < 0.05 for all treatments). In two studies, procyanidin oligomers exhibited greater efficacy over vehicle with response to mean change in hair density (hairs/cm2) (ps < 0.0001 at Week 24). In conclusion, prostaglandin analogs and polyphenols, such as latanoprost and procyanidin oligomers, can improve hair restoration parameters in male AGA patients, possibly through targeting mechanisms proposed in the etiology of AGA. The current evidence suggests short-term (24 weeks) use may provide benefit for hair loss patients; however, long-term efficacy and safety data are required.

Notes

Compliance with Ethical Standards

Funding

This paper was not funded.

Conflict of interest

Dr. Piguet reports receiving educational grants in his role as Department Division Director, Dermatology, University of Toronto (on behalf of the Division of Dermatology Residency Program) from Abbvie, Celgene, Janssen, Naos, Lilly, Sanofi, Valeant, and non-financial support from La Roche-Posay, outside the submitted work.

References

  1. 1.
    Crabtree JS, Kilbourne EJ, Peano BJ, Chippari S, Kenney T, McNally C, et al. A mouse model of androgenetic alopecia. Endocrinology. 2010;151(5):2373–80.CrossRefGoogle Scholar
  2. 2.
    Sadick NS, Callender VD, Kircik LH, Kogan S. New Insight into the pathophysiology of hair loss trigger a paradigm shift in the treatment approach. J Drugs Dermatol. 2017;16(11):135–40.Google Scholar
  3. 3.
    Christoph T, Müller-Röver S, Audring H, Tobin DJ, Hermes B, Cotsarelis G, et al. The human hair follicle immune system: cellular composition and immune privilege. Br J Dermatol. 2000;142(5):862–73.CrossRefGoogle Scholar
  4. 4.
    Rogaine® minoxidil topical 2% solution [Internet]. Government of Canada. 2017 [cited 2018 Sep 18]. Available from: https://pdf.hres.ca/dpd_pm/00040937.pdf.
  5. 5.
    Men’s Rogaine [Internet]. Drugs@FDA: FDA Approved Drug Products. 2006 [cited 2018 Sept 18]. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/021812s000LBL.pdf.
  6. 6.
    PROPECIA® (finasteride) tablets for oral use [Internet]. FDA U.S. Food and Drug Administration. 2016 [cited 2018 Sep 18]. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/020788s024lbl.pdf.
  7. 7.
    PROPECIA® Finasteride tablets, USP Film-coated Tablets 1 mg Type II 5α-reductase inhibitor [Internet]. Government of Canada. 2018 [cited 2018 Sep 18]. Available from: https://pdf.hres.ca/dpd_pm/00043972.PDF.
  8. 8.
    Berger RS, Fu JL, Smiles KA, Turner CB, Schnell BM, Werchowski KM, et al. The effects of minoxidil, 1% pyrithione zinc and a combination of both on hair density: a randomized controlled trial. Br J Dermatol. 2003;149(2):354–62.CrossRefGoogle Scholar
  9. 9.
    Blume-Peytavi U, Lönnfors S, Hillmann K, Garcia Bartels N. A randomized double-blind placebo-controlled pilot study to assess the efficacy of a 24-week topical treatment by latanoprost 0.1% on hair growth and pigmentation in healthy volunteers with androgenetic alopecia. J Am Acad Dermatol. 2012;66(5):794–800.CrossRefGoogle Scholar
  10. 10.
    Gassmueller J, Hoffmann R, Webster A. Topical fulvestrant solution has no effect on male and postmenopausal female androgenetic alopecia: results from two randomized, proof-of-concept studies. Br J Dermatol. 2008;158(1):109–15.Google Scholar
  11. 11.
    Greenberg JH, Katz M. Treatment of androgenetic alopecia with a 7.5% herbal preparation. J Dermatol Treat. 1996;7(3):159–62.CrossRefGoogle Scholar
  12. 12.
    Ito T, Fukamizu H, Ito N, Seo N, Yagi H, Takigawa M, et al. Roxithromycin antagonizes catagen induction in murine and human hair follicles: implication of topical roxithromycin as hair restoration reagent. Arch Dermatol Res. 2009;301(5):347–55.CrossRefGoogle Scholar
  13. 13.
    Iwabuchi T, Ideta R, Ehama R, Yamanishi H, Iino M, Nakazawa Y, et al. Topical adenosine increases the proportion of thick hair in Caucasian men with androgenetic alopecia. J Dermatol. 2016;43(5):567–70.CrossRefGoogle Scholar
  14. 14.
    Iwabuchi T, Takeda S, Yamanishi H, Ideta R, Ehama R, Tsuruda A, et al. The topical penta-peptide Gly-Pro-Ile-Gly-Ser increases the proportion of thick hair in Japanese men with androgenetic alopecia. J Cosmet Dermatol. 2016;15(2):176–84.CrossRefGoogle Scholar
  15. 15.
    Jo SJ, Shin H, Park YW, Paik SH, Park WS, Jeong YS, et al. Topical valproic acid increases the hair count in male patients with androgenetic alopecia: a randomized, comparative, clinical feasibility study using phototrichogram analysis. J Dermatol. 2014;41(4):285–91.CrossRefGoogle Scholar
  16. 16.
    Kamimura A, Takahashi T, Watanabe Y. Investigation of topical application of procyanidin B-2 from apple to identify its potential use as a hair growing agent. Phytomed Int J Phytother Phytopharmacol. 2000;7(6):529–36.Google Scholar
  17. 17.
    Kessels AG, Cardynaals RL, Borger RL, Go MJ, Lambers JC, Knottnerus JA, et al. The effectiveness of the hair-restorer ‘Dabao’ in males with alopecia androgenetica. A clinical experiment. J Clin Epidemiol. 1991;44(4–5):439–47.CrossRefGoogle Scholar
  18. 18.
    Lindenbaum ES, Feitelberg AL, Tendler M, Beach D, Gamliel-Lazarovich A, Har-Shai Y, et al. Pilot study of a novel treatment for androgenetic alopecia using enriched cell culture medium: clinical trials. Dermatol Online J. 2003;9(1):4.Google Scholar
  19. 19.
    Olsen EA, DeLong E. Transdermal viprostol in the treatment of male pattern baldness. J Am Acad Dermatol. 1990;23(3):470–2.CrossRefGoogle Scholar
  20. 20.
    Pumthong G, Asawanonda P, Varothai S, Jariyasethavong V, Triwongwaranat D, Suthipinittharm P, et al. Curcuma aeruginosa, a novel botanically derived 5α-reductase inhibitor in the treatment of male-pattern baldness: a multicenter, randomized, double-blind, placebo-controlled study. J Dermatol Treat. 2012;23(5):385–92.CrossRefGoogle Scholar
  21. 21.
    Takahashi T, Kamimura A, Kagoura M, Toyoda M, Morohashi M. Investigation of the topical application of procyanidin oligomers from apples to identify their potential use as a hair-growing agent. J Cosmet Dermatol. 2005;4(4):245–9.CrossRefGoogle Scholar
  22. 22.
    Safety and Efficacy Study of Bimatoprost in the Treatment of Men With Androgenic Alopecia—Study Results—ClinicalTrials.gov [Internet]. [cited 2018 Sept 18]. Available from: https://clinicaltrials.gov/ct2/show/results/NCT01325337.
  23. 23.
    A Safety and Efficacy Study of Bimatoprost in Men With Androgenic Alopecia (AGA)—Study Results—ClinicalTrials.gov [Internet]. [cited 2018 Sept 18]. Available from: https://clinicaltrials.gov/ct2/show/results/NCT01904721.
  24. 24.
    Johnstone M, Albert D. Prostaglandin-induced hair growth. Surv Ophthalmol. 2002;47(1):S185–202.CrossRefGoogle Scholar
  25. 25.
    Hiipakka RA, Zhang H-Z, Dai W, Dai Q, Liao S. Structure-activity relationships for inhibition of human 5alpha-reductases by polyphenols. Biochem Pharmacol. 2002;63(6):1165–76.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Mediprobe Research Inc.LondonCanada
  2. 2.Division of Dermatology, Department of MedicineUniversity of Toronto School of MedicineTorontoCanada
  3. 3.Division of DermatologySunnybrook Health Sciences CentreTorontoCanada
  4. 4.Division of DermatologyWomen’s College HospitalTorontoCanada
  5. 5.Division of Infection and ImmunityCardiff University School of MedicineCardiffUK
  6. 6.Dermatology, Department of Experimental, Diagnostic and Specialty MedicineUniversity of BolognaBolognaItaly

Personalised recommendations