Dutasteride Intralesional Microinjections in Combination With Oral Minoxidil vs Oral Minoxidil Monotherapy in Men With Androgenetic Alopecia Journal of the European Academy of Dermatology and Venereology: JEADV

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• In this retrospective single-center study, male patients with androgenetic alopecia were treated with oral minoxidil 1–5 mg daily alone (n = 58) or in combination with intralesional dutaseride microinjections (n = 47). A 2-mL solution comprising 1 mL of dutasteride 0.01% and 1 mL of normal saline was injected per session for 3 months. Observed side-effects were related to oral minoxidil in both groups, and no sexual dysfunction was reported in any participant.

• Combination therapy of oral minoxidil plus intralesional dutasteride led to significantly greater improvement at the vertex (P ≤ .001) compared with the outcomes of oral minoxidil monotherapy. Although large-scale and long-term studies are needed, the efficacy of this treatment and relief from the risk of sexual dysfunction may provide an alternative therapeutic option to men concerned about systemic adverse effects of oral 5α-reductase.

–  Caroline K. Crabtree, MD

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Paradi Mirmirani MD

Dutasteride, a potent inhibitor of 5-alpha reductase types I and II, has shown to be effective for hair growth in those with androgenetic alopecia. However, the concern for sexual side-effects has many patients and clinicians searching for localized methods of drug delivery to maximize hair growth while avoiding side-effects. Since dutasteride has a large molecular weight and high lipophilicity, cutaneous or follicular penetration of the drug is likely quite limited. Microinjections, or mesotherapy, has been advocated as another strategy for cutaneous, localized drug delivery. The authors of this study evaluated mesotherapy of dutasteride solution to the scalp used in combination with oral minoxidil compared with oral minoxidil alone.

While blinded investigators identified significant improvements of hair growth for the combination treatment compared with oral minoxidil alone at the vertex scalp, the patients were remarkably satisfied in both groups, with no statistically significant difference. The limitation of the study included lack of treatment blinding and retrospective data analysis. I would like to see the use of placebo injections to evaluate the possible role that the injections themselves had on hair growth, as can be seen with microneedling.

While the study suggests that there may be benefits of dutasteride mesotherapy at the vertex scalp when used along with oral minoxidil, one must consider that there is a significant added cost for this in-office procedure. Given that patients were equally satisfied with the use of single-agent low-dose oral minoxidil, I don't necessarily see a big need for the addition of the mesotherapy. Of note, the dutasteride 0.01% solution that was used for mesotherapy treatment in this study is not currently available in the US.

Abstract

Oral dutasteride (OD) is an effective treatment for androgenetic alopecia (AGA); many men are reluctant to treat their AGA with systemic 5α-reductase enzyme inhibitors due to risk of adverse sexual side-effects. Dutasteride intralesional injections may be a useful antiandrogens alternative therapy for AGA; however, information of its effectiveness is scarce. Our objective was to investigate the effectiveness and safety of the dutasteride intralesional microinjections (DIM) with oral minoxidil (OM) compared with OM monotherapy in men with AGA.

Journal of the European Academy of Dermatology and Venereology: JEADV

Dutasteride intralesional microinjections in combination with oral minoxidil vs. oral minoxidil monotherapy in men with androgenetic alopecia: a retrospective analysis of 105 patients

J Eur Acad Dermatol Venereol 2022 Mar 12;[EPub Ahead of Print], CD Villarreal-Villarreal, E Boland-Rodriguez, S Rodríguez-León, F Le Voti, S Vano-Galvan, RD Sinclair 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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