Combining topical minoxidil with procapil; an assessment of their comparative efficacy in androgenetic alopecia: A randomized control trail
DOI:
https://doi.org/10.66344/jpad.v34i2.2541Keywords:
Androgenetic alopecia, minoxidil, Androgenetic alopecia, Minoxidil, ProcapilAbstract
Introduction Androgenetic alopecia (AGA) is a commonly prevalent form of non-scarring alopecia mostly involving men. It involves 50% of men, and the prevalence increases with age. Its scalp involvement ranges from mild (I) to severe (VII) based on the Norwood scoring system. Multiple modalities have been tried for its treatment, including oral and topical minoxidil and finasteride. These treatment modalities have been successful in treating androgenetic alopecia up to a certain extent but are also associated with adverse effects. Very few studies are available on the efficacy of topical procapil, and none have compared it with minoxidil on a head to-head basis. The purpose of this study was to assess the efficacy of procapil in combination with minoxidil vs. minoxidil alone in the treatment of androgenetic alopecia.
Methods Using randomized sampling technique, 140 patients were enrolled in this study. Patients were divided into two groups, with 70 patients in each group. One-half of the patients used 5% minoxidil on a twice-daily basis (Group A), while the other half used procapil 5% alternated with minoxidil for 12 months (Group B). Both subjective and objective assessment tools were for hair regrowth evaluation in the form of an increase in the mean hair count as well as patients’ satisfaction and dermatologist assessment scores.
Results The mean age was 32.6±6.7 and 31.5±7.4 years in groups A and B, respectively. The baseline line hair count and grads of AA were also comparable in both groups. As compared to minoxidil alone, the combination therapy showed better results in terms of an increase in hair count (p value=0.0001), Patient satisfaction (p value=0.011), and Dermatologist assessment scores (p value=0.0054).
Conclusion The addition of procapil to minoxidil is more efficacious than minoxidil alone for the treatment of androgenetic alopecia.
References
1. Kaliyadan F, Nambiar A, Vijayaraghavan S. Androgenetic alopecia: an update. Indian J Dermatol Venereol Leprol. 2013;79(5):613.
2. Wang TL, Zhou C, Shen YW, Wang XY, Ding XL, Tian S, Liu Y, Peng GH, Xue SQ, Zhou JE, Wang RL. Prevalence of androgenetic alopecia in China: a community-based study in six cities. Br J Dermatol. 2010;162(4):843-7.
3. Sadiq S, Naveed T, Naveed S, Minhas IJ, Khan BM, Sadiq S. Using Skindex-29 Scale to Assess The Impact of Androgenetic/Patterned Hair Loss on Quality of Life of Patients in Pakistan. Pak Armed Forces Med J. 2022;72(1):42-6.
4. Blumeyer A, Tosti A, Messenger A, Reygagne P, Del Marmol V, Spuls PI, Trakatelli M, Finner A, Kiesewetter F, Trüeb R, Rzany B. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men. J Dtsch Dermatol Ges. 2011;9 Suppl 6:S1-57.
5. Lolli F, Pallotti F, Rossi A, Fortuna MC, Caro G, Lenzi A, Sansone A, Lombardo F. Androgenetic alopecia: a review. Endocrine. 2017;57(1):9-17.
6. Matsumura H, Mohri Y, Binh NT, Morinaga H, Fukuda M, Ito M, Kurata S, Hoeijmakers J, Nishimura EK. Hair follicle aging is driven by transepidermal elimination of stem cells via COL17A1 proteolysis. Science. 2016;351(6273):aad4395.
7. Rathnayake D, Sinclair R. Male androgenetic alopecia. Expert Opin Pharmacother. 2010 Jun;11(8):1295-304.
8. Rossi A, Anzalone A, Fortuna MC, Caro G, Garelli V, Pranteda G, Carlesimo M. Multi-therapies in androgenetic alopecia: Review and clinical experiences. Dermatol Ther. 2016;29(6):424-32.
9. Okeigwe I, Kuohung W. 5-Alpha reductase deficiency: a 40-year retrospective review. Curr Opin Endocrinol Diabetes Obes. 2014;21(6):483-7.
10. Leiros GJ, Attorresi AI, Balaña ME. Hair follicle stem cell differentiation is inhibited through cross-talk between Wnt/β-catenin and androgen signalling in dermal papilla cells from patients with androgenetic alopecia. Br J Dermatol. 2012;166(5):1035-42.
11. Kaliyadan F, Nambiar A, Vijayaraghavan S. Androgenetic alopecia: an update. Indian J Dermatol Venereol Leprol. 2013;79(5):613.
12. Sattur SS, Sattur IS. Present and Future Treatments of Androgenic Alopecia. In: Trüeb RM, Tobin DJ, editors. Aging Hair. 2010:263-77.
13. Hsu CL, Liu JS, Lin TW, Chang YH, Kuo YC, Lin AC, Ting HJ, Pang ST, Lee LY, Ma WL, Lin CC. Characterization of a novel androgen receptor (AR) coregulator RIPK1 and related chemicals that suppress AR-mediated prostate cancer growth via peptide and chemical screening. Oncotarget. 2017;8(41):69508.
14. Lee NE, Park SD, Hwang H, Choi SH, Lee RM, Nam SM, Choi JH, Rhim H, Cho IH, Kim HC, Hwang SH. Effects of a gintonin-enriched fraction on hair growth: an in vitro and in vivo study. J Ginseng Res. 2020;44(1):168-77.
15. Shorter K, Farjo NP, Picksley SM, Randall1 VA. Human hair follicles contain two forms of ATP-sensitive potassium channels, only one of which is sensitive to minoxidil. FASEB J. 2008;22(6):1725-36.
16. Kwack MH, Kang BM, Kim MK, Kim JC, Sung YK. Minoxidil activates β-catenin pathway in human dermal papilla cells: A possible explanation for its anagen prolongation effect. J Dermatol Sci. 2011;62(3):154-9.
17. Messenger AG, Rundegren J. Minoxidil: mechanisms of action on hair growth. Br J Dermatol. 2004;150(2):186-94.
18. Wirya CT, Wu W, Wu K. Classification of male-pattern hair loss. Int J Trichol. 2017;9(3):95.
19. Shankar DK, Chakravarthi M, Shilpakar R. Male androgenetic alopecia: population-based study in 1,005 subjects. Int J Trichol. 2009;1(2):131.
20. Nestor MS, Ablon G, Gade A, Han H, Fischer DL. Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics. J Cosmet Dermatol. 2021;20(12):3759-81.
21. Rundegren J. A one-year observational study with minoxidil 5% solution in Germany: results of independent efficacy evaluation by physicians and patients 1. J Am Acad Dermatol. 2004;50(3 Suppl):P91.
22. Ghonemy S, Alarawi A, Bessar H. Efficacy and safety of a new 10% topical minoxidil versus 5% topical minoxidil and placebo in the treatment of male androgenetic alopecia: a trichoscopic evaluation. J Dermatolog Treat. 2021;32(2):236-41.
23. Arca E, Açıkgöz G, Taştan HB, Köse O, Kurumlu Z. An open, randomized, comparative study of oral finasteride and 5% topical minoxidil in male androgenetic alopecia. Dermatology. 2004;209(2):117-25.
24. Balasundaram M, Kumari R, Ramassamy S. Efficacy of autologous Platelet-rich plasma therapy versus topical Minoxidil in men with moderate androgenetic alopecia: A randomized open-label trial. J Dermatolog Treat. 2023;34(1):2182618.
25. Eslahi E, Hashemi N, Shamaei S. Effectiveness of the active ingredients (Capixyl, Procapil, and rosemary extract) of the Trust J tonic for the treatment of androgenetic alopecia in comparison to minoxidil. Our Dermatol Online. 2022;13(4):346-51.
26. Karaca N, Akpolat ND. A comparative study between topical 5% minoxidil and topical "Redensyl, Capixyl, and Procapil" combination in men with androgenetic alopecia. J Cosmetol Trichol. 2019;150370987.
27. Leiros GJ, Attorresi AI, Balaña ME. Hair follicle stem cell differentiation is inhibited through cross-talk between Wnt/β-catenin and androgen signalling in dermal papilla cells from patients with androgenetic alopecia. Br J Dermatol. 2012;166(5):1035-42.
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