Efficacy of Cetirizine 1% Versus Minoxidil 5% Topical Solution in the Treatment of Male Alopecia: A Randomized, Single-blind Controlled Study
Delaram Hossein MostafaAniseh SamadiSomayeh NiknamSaman Ahmad NasrollahiAlexandre GuishardAlireza Firooz
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Prostaglandins play a pivotal role in modulating hair growth cycle. Prostaglandin F2α and prostaglandin E have stimulating and prostaglandin D has inhibitory effects on hair follicle. Cetirizine inhibits release of prostaglandin D2 and stimulates the release of prostaglandin E2. In the present study, the efficacy and safety of twice daily application of topical cetirizine 1% versus minoxidil 5% solutions for 16 weeks were compared in male androgenetic alopecia (AGA).Forty men, aged 18 to 49 years, were randomly divided into two equal groups to apply either cetirizine 1% or minoxidil 5% solutions. The study was divided into two phases, a 16-week treatment phase either with cetirizine or minoxidil (anagen phase), followed by an 8-week drug-free (telogen phase) with a follow-up when patients used placebo. Efficacy outcomes included the change in total hair density, vellus and terminal hair density, hair diameter and the percentage of hair in anagen and telogen phases from baseline in 16 and 24 weeks.After 16 weeks, we observed a significant increase in total and vellus hair density in both minoxidil and cetirizine groups, but the improvement was much higher in the minoxidil group. The percentage of hair in the anagen phase also increased in both groups after 16 weeks of treatment, but then diminished after 8 weeks of placebo consumption. No significant adverse reactions associated with the administration of cetirizine solution were reported.Cetirizine 1% solution was effective in hair growth without any complications for treatment of male AGA.Keywords:
Minoxidil
Cetirizine
Vellus hair
Prostaglandin D2
Minoxidil 2% topical solution applied twice a day is known to induce hair growth and prevent hair loss in normal male pattern baldness. Based on this potential, this pilot study tested the effect of Minoxidil on hair loss during chemotherapy for gynecologic cancers. Ten women about to start alopecia-inducing chemotherapy protocols were entered into this non-randomized prospective trial. By study design, each patient served as her own control, as only a portion of the scalp was treated with Minoxidil. Four of the ten patients were unevaluable for failing to comply with the twice-a-day Minoxidil application schedule. Of the six evaluable patients, five experienced complete or severe symmetrically diffuse hair loss, all of which occurred within four weeks of initiating chemotherapy. One patient had no hair loss in either the treatment or control area. Application of the topical Minoxidil in all ten patients had no untoward side effects, skin changes or hypotension. Thus, in this pilot study, 2% Minoxidil was non-toxic but showed no benefit in the prevention of chemotherapy-induced alopecia.
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Background: Patterned hair loss, follicular miniaturization, and increased telogen hair counts characterize androgenic alopecia (AGA). Follicular inflammation in AGA has been associated with treatment resistance and progressive hair loss. Case report: Brothers, 15 and 18 years old, presented with frontal and mid‐scalp hair loss with an intact frontal hairline noted over a 1‐year period. The elder reported past use of androgenic steroids. Laboratory assessment for metabolic and hormonal abnormalities was unrevealing, and hair pull test was negative. Scalp biopsies revealed decreased terminal hairs, marked diameter variation of anagen hairs, decreased terminal to vellus hair ratios (3.7:1/3.4:1, older/younger), and increased telogen counts (23%/21%). Infrabulbar and peri‐isthmic (follicular bulge region) lymphocytic infiltrates were present. Hair loss has progressed, unabated by daily topical 0.5% clobetasol (for 6 months), daily 5% minoxidil (1 year), and latter, daily oral finasteride (2 years – older brother only). Discussion: Based on patterned hair loss and miniaturized hairs, these brothers have AGA. The female pattern of hair loss (diffuse hair loss affecting the central scalp with preservation of frontal hair line) coupled with follicular isthmic lymphocytic inflammation represents an unusual presentation, possibly a treatment resistant, inflammatory variant of AGA. The differential diagnosis includes exogenous androgen‐mediated hair loss, cicatricial pattern hair loss, or the superimposition of alopecia areata.
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Female pattern hair loss (FPHL) is the most prevalent form of hair loss in women. It was aimed to evaluate the therapeutic effects of topical cetirizine 1%, versus topical minoxidil 2% in patients with FPHL.Through a triple-blind randomized clinical trial, 60 women with FPHL were randomly divided into two groups of treatment with topical cetirizine 1% or topical minoxidil 2%. The endpoint was changing in hair loss severity as well as terminal hair density and diameter, according to trichoscopic evaluation. Intention-to-treat analysis was also performed for those who accomplished 3 months of treatment.Both groups showed improvement in hair diameter and density after 6 months; however, the outcome was significant only in the minoxidil group. According to per-protocol analysis, minoxidil was significantly superior to cetirizine in hair density, but not in hair diameter. According to the hair loss severity scales, FPHL was significantly improved in both the cetirizine and minoxidil groups after 6 months of therapy. The dropout rate due to adverse effects was 10.0% and 6.6% in the cetirizine and minoxidil groups, respectively.Although inferior to topical minoxidil, topical cetirizine can provide favorable therapeutic effects for FPHL, specifically when patient incompatibility with Minoxidil is observed.The study is registered in the Iranian Registry of Clinical Trials (IRCT) with the registration code IRCT20200521047536N1.
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Abstract Background: Androgenetic alopecia (AGA) is a form of non-scarring scalp hair loss that affects more than 50% of males. Prostaglandins would have an important role in hair growth and their action is variable according to their class. Based on these and the scarce studies that suggest the effectiveness of cetirizine on AGA we carried out this study. Aim of Work: Dermoscopic evaluation of the efficacy of topical cetirizine 1 % in male patients with androgenetic alopecia. Materials and methods: A prospective study was carried out on 50 Egyptian male patients treated with topical cetirizine 1% formula once daily. The clinical and dermoscopic examination was done before, during, and after treatment to evaluate the response. Results: There was a significant increase in the number of terminal hairs, a decrease in the number of vellus hair, and hair diameter diversity after treatment. There was mild to good photographic improvement. Conclusion: Topical cetirizine 1 % had a promising effect in the treatment of AGA in men after 4 months of treatment. It also is having an excellent safety profile which could be an excellent option in the near future for the patients.
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Minoxidil is a Health Canada and US FDA-approved medication for hair loss in men and women. While 5% minoxidil foam has been approved for men since 2006, Health Canada and the FDA only approved 5% minoxidil foam for female pattern hair loss (FPHL) in 2014. Recent Phase III clinical trials demonstrated the efficacy of once daily 5% minoxidil foam for treatment of FPHL, where a significant change from baseline in the target area hair count was observed compared to placebo. Similar changes in hair count for 5% foam and twice daily 2% minoxidil solution established noninferiority of the 5% foam formulation. Five percent minoxidil foam provides an additional option for women with FPHL and will soon be available in Canada.
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Introduction . Androgenetic alopecia (AGA) is the most common type of alopecia, characterized by diffuse progressive thinning of the hair in the fronto-parietal area in patients with a genetic predisposition. Topical minoxidil remains the primary pharmacological treatment for AGA both in men and women. The efficacy in hair regrowth is reported to be between 40 and 50%. Aim. To evaluate prognostic factors of minoxidil response in AGA patients. Matherials and methods. The prospective open study was carried out. Thirty participants with AGA were enrolled and completed the study (twenty one women I–II Ludwig stage and nine men I–III Hamilton – Norwood stage). Primary outcomes consisted of measuring of hair density, telogen hair rate, the percentage of vellus hairs and hair diameter at baseline and repeated at 4 months. The SULT1A1 enzyme activity and the concentration of ATP in plucked hairs were measured at baseline. Patients were treated with 5% topical minoxidil applying daily for 4 months. In order to investigate prognostic factors in groups of responders and non-responders to minoxidil treatment these measured morphometric and biochemical characteristics were assessed. Results . After 4 months of treatment 77% of patients demonstrated hair regrowth and improvement of hair density, hair diameter and decrease of vellus hairs level. The SULT1A1 enzyme activity (p = 0.0008), the concentration of ATP (p = 0.004) in plucked hairs and baseline total hair density (p = 0.01) was significantly lower in group of non-responders compared to group of responders. The study demonstrated strong positive correlation between SULT1A1 enzyme activity and increase of total hair density (r = 0.7, р = 0.00002); moderate positive correlation was founded between concentration of ATP and increase of total hair density (r = 0.6, р = 0.0004). Conclusion . The negative prognostic factors for minoxidil treatment of AGA include SULT1A1 enzyme activity, concentration of ATP in plucked hairs and low total hair density at baseline.
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