Effectiveness and safety of the combination therapy of micro-needling and minoxidil in androgenetic alopecia of Indonesian men: a randomized controlled trial

Androgenetic alopecia (AGA) is the most common type of hair loss. Treatment options are limited. Microneedling, a minimally invasive technique can enhance hair growth by releasing growth factors. However, no standardized protocol for frequency, depth and duration is available. This study aimed to determine the effectiveness and safety of the combination therapy of microneedling and minoxidil in AGA. This study was a randomized controlled clinical trial conducted over 12 weeks. The intervention group received a 4-weekly combination therapy of microneedling + 5% minoxidil, while the control group got only topical 5% minoxidil. Hair density and diameter were assessed using FotoFinder® trichoscale (Fotofinder Systems GmBH, Bad Birnbach, Germany) every 4 weeks. A total of 36 male participants, between 26-51 years old, with Hamilton-Norwood type III-VI AGA were included. At the end of the study, the intervention group had significantly higher hair density (95.6 vs 52.4 hair/cm^2, p<0.001) and diameter (18 vs 6 μm, p=0.004) than the control group. Side effects, included itching and transient erythema, were well tolerated. The combination of 4-weekly microneedling and topical 5% minoxidil is effective in increasing both hair density and hair diameter, and safe to use in AGA patients.