A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study

Abstract

Introduction: Dermal papilla (DP) is the site of expression of various hair growth related genes. Various researches have demonstrated the underlying importance of Wnt proteins and wound growth factors in stimulating DP associated stem cells. Microneedling works by stimulation of stem cells and inducing activation of growth factors.

Materials and methods: Hundred cases of mild to moderate (III vertex or IV) androgenetic alopecia (AGA) were recruited into 2 groups. After randomization one group was offered weekly microneedling treatment with twice daily 5% minoxidil lotion (Microneedling group); other group was given only 5% minoxidil lotion. After baseline global photographs, the scalp were shaved off to ensure equal length of hair shaft in all. Hair count was done in 1 cm(2) targeted fixed area (marked with tattoo) at baseline and at end of therapy (week 12). The 3 primary efficacy parameters assessed were: Change from baseline hair count at 12 weeks, patient assessment of hair growth at 12 weeks, and investigator assessment of hair growth at 12 weeks. A blinded investigators evaluated global photographic response. The response was assessed by 7- point scale.

Results: (1) Hair counts - The mean change in hair count at week 12 was significantly greater for the Microneedling group compared to the Minoxidil group (91.4 vs 22.2 respectively). (2) Investigator evaluation - Forty patients in Microneedling group had +2 to +3 response on 7-point visual analogue scale, while none showed the same response in the Minoxidil group. (3) Patient evaluation - In the Microneedling group, 41 (82%) patients reported more than 50% improvement versus only 2 (4.5%) patients in the Minoxidil group. Unsatisfied patients to conventional therapy for AGA got good response with Microneedling treatment.

Conclusion: Dermaroller along with Minoxidil treated group was statistically superior to Minoxidil treated group in promoting hair growth in men with AGA for all 3 primary efficacy measures of hair growth. Microneedling is a safe and a promising tool in hair stimulation and also is useful to treat hair loss refractory to Minoxidil therapy.

Keywords: Androgenetic alopecia; Microneedling; dermaroller; hair re-growth; signaling pathways.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1

(a) A specialized adapter attached to the camera; and (b) Photograph of scalp taken at a fixed distance with the help of the adapter

Figure 2

Photographs were printed on Kodak A4 matt-photography paper and hair were counted by an independent investigator

Figure 3

(a) New hair growth was calculated by subtracting hair count at baseline; and (b) From hair count at week 12

Figure 4

Stereotactic head positioning device with mounted camera

Figure 5

Mean hair counts at baseline and at end of 12 weeks in the Microneedling and Minoxidil treated group

Figure 6

Grade 3 response on 7-point evaluation scale in the Microneedling treated group

Figure 7

Grade 0 response on 7-point evaluation scale in patient no. 1 and grade + 1 response in patient no. 2 in the Minoxidil treated group

Figure 8

Earlier and faster hair re-growth at 1 week noted in Microneedling treated group