Trichogenic effect of topical ketoconazole versus minoxidil 2% in female pattern hair loss: a clinical and trichoscopic evaluation

Ahmed El-Garf,Mohamed Mohie,Eman Salah

doi:10.1186/s41702-019-0046-y

Ahmed El-Garf, Mohamed Mohie + Show 1 more

Open Access

https://doi.org/10.1186/s41702-019-0046-y

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Journal: Biomedical Dermatology	Publication Date: Dec 1, 2019
Citations: 4	License type: open-access

Affiliation: Zagazig University

Abstract

BackgroundFemale pattern hair loss (FPHL) is a common non-scaring alopecia. Topical minoxidil is the only approved treatment for FPHL; however, it has frequent side effects. Ketoconazole is an antifungal with anti-androgenic properties.MethodsThe aim of this work was to evaluate the safety and possible trichogenic effects of ketoconazole in FPHL. Patients were randomly assigned into Group A with 20 patients who received 2% topical minoxidil solution and Group B involving 20 patients who were treated by 2% topical ketoconazole preparation. All patients were treated for 6 months and evaluated clinically plus via trichoscopy. Side effects were recorded, and patients’ satisfaction was measured.ResultsRegarding hair growth, a significant difference was detected between baseline and at 4th and 6th months in Group A. While in Group B, the improvement was delayed until the 6th month. Only 10% of Group B reported side effects. Patients’ satisfaction did not differ between the two groups.ConclusionsTopical ketoconazole mediates a trichogenic effect in FPHL with few side effects. However, ketoconazole showed a delayed improvement versus minoxidil at similar concentrations. Further studies should evaluate the efficacy of higher concentrations of ketoconazole solutions for FPHL which is a promising therapy.Trial registrationIRB approval status: reviewed and approved by IRB of Faculty of Medicine, Zagazig University; approval no. #3642

Highlights

Since ancient times, there is no doubt that hair is one of the most determining features of a woman’s appearance
In 2014, topical minoxidil at 5% concentration was approved by both the Food and Drug Administration (FDA) and Health Canada for Female pattern hair loss (FPHL) (Kanti et al 2018)
The trichogenic effects of minoxidil can be explained by its ability to increase the anagen phase and decrease the telogen phase of the hair cycle, to promote the rate of hair growth and through its augmented proliferative and vasodilatory actions (Messenger and Rundegren 2004)

Summary

Introduction

There is no doubt that hair is one of the most determining features of a woman’s appearance. Female pattern hair loss (FPHL) is a non-scarring alopecia characterized by gradual and progressive miniaturization of hair follicles or terminal to villus hair shift (Trueb 2002). FPHL patients show a reduced hair density over the crown and frontal scalp with preservation of anterior hairline or Initially, the Food and Drug Administration (FDA) has approved the twice-daily application of 1 ml of topical minoxidil 2% solution to treat FPHL (Blumeyer et al 2011). In 2014, topical minoxidil at 5% concentration was approved by both the FDA and Health Canada for FPHL (Kanti et al 2018). Female pattern hair loss (FPHL) is a common non-scaring alopecia. Topical minoxidil is the only approved treatment for FPHL; it has frequent side effects.

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