Platelet-rich plasma microneedling versus 5% topical minoxidil in the treatment of patterned hair loss

Background Patterned hair loss (PHL) is a distressing common problem. It is associated with progressive reduction in hair density and hair fiber thickness, affecting mainly the frontovertical regions of the scalp. The available lines of treatment are not uniformly effective. Platelet-rich plasma and microneedling have been introduced recently to the armamentarium of treatment. Their comparative efficacy to topical minoxidil has not been evaluated. Objective To assess the efficacy of combined PRP mesotherapy and microneedling in the treatment of PHL compared with 5% topical minoxidil. Patients and methods Forty patients with clinically diagnosed PHL were recruited after exclusion of other causes of hair loss. They were divided into two equal age-matched, sex-matched, and severity-matched groups. The first group received 2ml of 5% topical minoxidil, whereas the other group received monthly sessions of combined platelet-rich plasma mesotherapy and scalp microneedling. The effect of the treatment was evaluated by a blinded investigator who graded the patient's alopecia and performed a nonvellus hair count in a target area after 12 and 28 weeks of treatment. Patients' satisfaction with treatment, their reported change in hair shedding rate, and side effects were recorded. Results Both treatment modalities were comparably effective in improving hair density and alopecia grade. Patients' satisfaction was comparable with both modalities. Both lines were well tolerated; however, the onset of action of minoxidil was significantly quicker. Conclusion Topical minoxidil remains the first-line of treatment for patients with PHL, given its efficacy, tolerability, and relatively low cost. Platelet-rich plasma with microneedling could be considered an effective second-line therapy for intolerant or unfit patients for minoxidil.