Androgenetic Alopecia: Therapy Update

Whether the transient hair shedding phase exist after minoxidil treatment and does it predict treatment efficacy? A retrospective study in androgenetic alopecia patients

PURPOSE

Minoxidil is a routinely used drug in treating multiple hair disorders. This study aimed to investigate the facticity of the temporal increase in the hair shedding amount after topical use of minoxidil.

MATERIALS AND METHODS

We selected 49 patients who used 2% or 5% minoxidil topically to treat androgenetic alopecia for 24 weeks. The amount of hair shedding was recorded every four weeks before and after the treatment. The BASP classification and trichoscopy test results were also recorded before and after the treatment. The relative amount of hair shedding (RAHS) was defined as the recorded number of hair shedding after normalization. The correlation between the maximum RAHS (MRAHS) and the sulfotransferase activity as well as the therapeutic effect was calculated.

RESULTS

A temporary increase in the amount of hair shedding was detected in the first 12 weeks. This increase has a longer duration in patients treated with 2% minoxidil compared to 5%. Its severity was correlated with the improvement of trichoscopy tests only in patients with 5% minoxidil but not in 2%. However, both patients in the 2% and 5% minoxidil groups had a significant association between the MRAHS and the improvement in BASP classification.

CONCLUSION

The amount of hair shedding increases temporarily after the topical minoxidil use, the level of which is a potential treatment efficacy.

Berberine promotes hair growth by targeting Axin2 and activating Wnt/β-catenin pathway

BACKGROUND

Androgenetic alopecia (AGA) is the most common type of hair loss, with high incidence of comorbidities such as polycystic ovary syndrome (PCOS), metabolic syndrome, insulin resistance and cardiovascular diseases. Berberine (BBR) has been widely used clinically to treat diarrhea in China for a long time. Although recent studies have revealed its therapeutic potential in comorbidities of AGA, there are few reports on its regulatory effects on hair growth.

PURPOSE

To explore the effects of BBR on hair loss and its mechanism.

METHODS

Human dermal papilla cells (hDPCs), normal and miniaturized hair follicles (HFs) were employed to evaluate the impact of BBR on hair growth in vitro. Depilation-induced hair growth mouse model was used to find the optimum concentration of BBR in vivo. Network pharmacology, RNA sequencing, cell transfection and reporter gene assay, immunohistochemistry, and molecular docking verification were used to explore the molecular mechanisms.

RESULTS

These models revealed that BBR enhanced the proliferation of hDPCs, increased the length of both normal and miniaturized HFs, and prolonged the anagen phase. In the depilation-induced hair growth mouse model and histological staining, BBR treatment significantly accelerated hair growth, facilitated the transition to the anagen phase, and prolonged its duration. Mechanistic studies confirmed that BBR promoted hair growth through regulating cell cycle, mediated by targeting Axin and activating the Wnt/β-catenin pathway. Importantly, knockdown of Axin2 reduced BBR's ability to enhance hDPCs proliferation.

CONCLUSIONS

These results suggested that BBR promotes hair growth by targeting Axin2 and activating Wnt/β-catenin pathway, presenting a promising therapeutic avenue for hair loss treatment.

Liposomes enhance the hair follicle delivery of minoxidil sulfate with improved treatment of androgenic alopecia

Androgenic alopecia (AGA) represents one of the most prevalent forms of hair loss. Liposomes (LPSs), acting as a localized dermal drug reservoir with sustained release property, can effectively prolong and enhance drug retention within the skin. Minoxidil sulfate (MXS), a potent active metabolite of minoxidil (MX) for promoting hair growth, exhibits instability in aqueous solution and faces difficulties in depositing within the deep dermal hair follicle regions. In this study, MXS-LPSs were fabricated via the thin-film hydration-dispersion method combined with an ammonium sulfate gradient active drug loading process, and their physicochemical characteristics were comprehensively characterized. The skin permeation/deposition properties of the drug from the MXS-LPSs were investigated by Franz diffusion cell method on ex vivo rat skin, and the mechanism underlying the targeted drug delivery of LPSs to hair follicles was explored by confocal laser scanning microscopy (CLSM). The pharmacodynamic evaluation of MXS-LPSs was carried out in AGA model rats. The optimized MXS-LPSs were uniformly dispersed with enhanced stability. The average vesicle size of MXS-LPSs was 129.46 ± 7.04 nm, the zeta potential was -25.57 ± 4.79 mV, the encapsulation efficiency (EE) was 92.72 ± 0.75 %, and the drug loading (DL) was 2.80 ± 0.12 %. The results of ex vivo skin permeation/deposition showed that the cumulative permeated drug amount (Qn) from MXS-LPS, MX tincture and MXS solution at 36 h was 225.98 ± 11.53, 19.79 ± 1.97 and 584.42 ± 2.33 μg·cm-2, respectively. The deposited drug amount in the skin beneath the stratum corneum from MXS-LPSs, MX tincture and MXS solution accounted for about 59.80 ± 26.27 %, 43.18 ± 6.58 % and 32.55 ± 1.61 % of that in the whole skin, respectively. It is remarkable that MXS-LPSs showed a considerably increased accumulation in hair follicles when compared to MXS solution. The results of pharmacodynamic tests demonstrated that, compared to MX tincture, MXS-LPSs could more effectively stimulate hair regrowth and avoided the adverse effects. Importantly, the MXS-LPSs also reduced skin irritation and sensitization. Consequently, MXS-LPSs hold substantial promise in the treatment of AGA.

Extracellular vesicles in age-related diseases: disease pathogenesis, intervention, and biomarker

Aging is a multifactorial biological process characterized by the irreversible accumulation of molecular damage, leading to an increased risk of age-related diseases. With the global prominent rise in aging populations, elucidating the mechanisms underlying the aging process and developing strategies to combat age-related diseases have become a pressing priority. Extracellular vesicles (EVs) have gained significant attention due to their role in intercellular communication. EVs are known for their ability to deliver biocargoes, such as miRNA, proteins, and lipids, implicating their involvement in disease pathogenesis and intervention. In this review article, we explore the dual role of EVs in age-related diseases: contributing to the pathogenesis of diseases by transferring deleterious molecules, while also offering therapeutic ability by transferring beneficial molecules. We also highlight the application of EVs as biomarkers for early diagnosis of age-related diseases, paving the way for early intervention and precision medicine. Additionally, we discuss how analysing the composition of EVs cargo can provide insights into disease progression. Finally, we address the challenges and future perspectives of EV-based-therapy in clinical translation, including standardization of EVs isolation methods and improving cargo specificity.

Hyperbranched polymer dots enhance hair follicle regeneration via Wnt/β-catenin activation: A drug-free nanozyme-based approach to hair growth therapy

BACKGROUND

Hair loss affects millions worldwide, yet current pharmacological treatments remain limited in efficacy and long-term sustainability. The Wnt/β-catenin pathway plays a crucial role in hair follicle regeneration, providing a promising target for novel therapeutic interventions.

METHODS

This study investigates the potential of Hyperbranched Polymer Dots (HPD) as a novel nanotherapeutic for hair follicle regeneration. Using a C57BL/6 mouse model, we assessed the effects of topically applied HPD on hair growth, follicular proliferation, and key molecular markers of follicular activation. Optical coherence tomography (OCT), histological analysis, and immunofluorescence staining for Ki67 and β-catenin were performed to evaluate follicular activity at multiple time points.

RESULTS

HPD treatment significantly accelerated hair regrowth (p < 0.05) and enhanced follicular density compared to minoxidil-treated controls. Immunofluorescence analysis revealed upregulation of Ki67 and β-catenin, indicating enhanced follicular stem cell proliferation and activation of the Wnt/β-catenin pathway. Furthermore, HPD-treated mice exhibited increased melanin deposition, suggesting early follicular entry into the anagen phase.

CONCLUSION

Our findings demonstrate that HPD serves as a potent activator of hair follicle regeneration, surpassing the efficacy of conventional minoxidil treatment. By modulating Wnt/β-catenin signaling and enhancing follicular proliferation, HPD presents a promising nanomedicine-based approach for non-invasive hair restoration therapies. Future studies should focus on optimizing HPD formulations for clinical translation in treating androgenetic alopecia and related hair disorders.

Oxyresveratrol enhances hair regeneration in human dermal papilla cell and androgenetic alopecia mouse model

Alopecia, or hair loss, is a common dermatological condition caused by multiple factors. Oxyresveratrol (ORV), a compound derived from the heartwood of Artocarpus lakoocha, is recognized for its potent antioxidant properties, with recent studies highlighting its anti-inflammatory effect across various cell types. This study aims to explore the therapeutic potential of ORV in treating alopecia. We evaluated the effects of ORV on Human Follicle Dermal Papilla Cells (HFDPCs) and an androgenetic alopecia (AGA) mouse model. Oxidative stress in HFDPCs was induced using hydrogen peroxide (H2O2), and dihydrotestosterone (DHT) was used to simulate AGA in both HFDPCs and C57BL/6NJcl mice. Our finding demonstrated that ORV significantly enhanced HFDPCs proliferation. In H2O2-induced oxidative stress conditions, pretreatment with ORV decreased reactive oxygen species (ROS) levels and reduced the production of pro-inflammatory cytokine. In the AGA model, ORV inhibited β-Catenin phosphorylation in HFDPCs, thereby promoting hair growth and maintaining skin thickness, hair bulb size, and count in mice. Overall, ORV demonstrated anti-inflammatory and hair-regenerative effects in both in vitro and in vivo models of alopecia. These findings suggest that ORV is a promising candidate for the treatment of hair loss.

Hyaluronic Acid Microneedles Loaded with Chinese Herbal Extracts as an Intradermal Delivery System for Hair Regeneration

Androgenic alopecia is one of the most common chronic problems for dermatologists worldwide. Some Chinese herbal extracts have been shown to promote hair growth, but the active ingredients are difficult to enter the dermis. Therefore, delivering the active ingredients into the dermis becomes a key factor. Herein, Platycladus orientalis leaf extract (PO-ex) was obtained using ethanol as a solvent, and then hyaluronic acid methacrylate/hyaluronic acid (HAMA/HA) hydrogel was loaded with PO-ex to prepare hyaluronic acid microneedles (PO-ex MN). The double cross-linked HAMA/HA provides sufficient mechanical strength to pierce the stratum corneum and deliver PO-ex into the dermis; PO-ex can effectively improve the environment for hair follicle cell proliferation by removing reactive oxygen free radicals; in addition, the self-repair reaction caused by microneedle mechanical stimulation activates the Wnt/β-catenin pathway associated with trauma repair and promotes hair follicle growth. PO-ex MN is a potential therapeutic strategy for the treatment of androgenic alopecia.

Transcriptomics sequencing reveals Qu-shi-yu-fa Decoction promotes hair cycle and keratinization by upregulating FOXN1 and TGM3 to treat androgenetic alopecia

BACKGROUD

As a prevalent type of hair loss, androgenetic alopecia (AGA) is complex due to the interplay of multiple factors, which has led to a long-standing exploration gap in the field of drug treatment. Qu-shi-yu-fa Decoction (QSYF), a traditional prescription, has shown positive effects on AGA in clinical practice, but its exact therapeutic mechanism has not been fully revealed.

PURPOSE

This study aimed to elucidate the mechanism of QSYF in the treatment of AGA.

METHODS

Identification of active components of QSYF using UPLC-MS/MS analysis. An AGA model was established for C57bL/6 mice using dihydrotestosterone to assess the effects of QSYF. Hair growth was observed using dermoscopy. Skin tissues were examined histologically using hematoxylin and eosin (H&E) staining. RNA-seq was performed on mouse skin samples to identify biological processes and targets. Biological processes and targets obtained from RNA-seq analysis were evaluated using Western blotting, RT-PCR and immunofluorescence assays. Mice were treated with target inhibitors and observed for hair growth for reverse validation. Network pharmacology was utilized to identify the key signaling pathways through which the targets functioned, and Western blotting was utilized for validation.

RESULTS

The study identified 43 QSYF components.QSYF promoted hair regeneration and increased hair bulb diameter and skin thickness in AGA mice. Transcriptome analysis showed that hair cycle and keratinization were important biological processes in QSYF treatment of AGA, while QSYF could upregulate the expression of key targets FOXN1 and TGM3. Reverse experiments showed that Inhibition of FOXN1 and TGM3 leads to exacerbation of AGA. Network pharmacological analysis showed that QSYF regulation of hair cycle and keratinization involves activation of PI3K-AKT and MAPK signaling.

CONCLUSION

This study demonstrates for the first time that QSYF regulates the hair cycle by up-regulating the expression of FOXN1 and promotes keratinization by up-regulating the expression of TGM3, both of them together exerting therapeutic effects on AGA.

Menopause and hair loss in women: Exploring the hormonal transition

Menopause, which is defined as the cessation of menstruation, may be preceded by hormonal fluctuations during the transition to menopause, up to 10 years prior. During this time, hormonal changes, including the relative increase in androgens and the cessation of ovarian estrogen production directly impacts the hair follicle, which is an estrogen-sensitive tissue. These hormonal fluctuations can lead to alterations in the hair shaft and hair cycle, including decreased density, decreased caliber, and changes in hair texture. Additionally, loss of estrogen after the onset of menopause may lead to sub-optimal metabolic and vascular functioning of the follicular unit. The overall decline in hair density, appearance and manageability can have significant emotional impact and affect overall mental health, with feelings of stress, anxiety, and diminished self-esteem. In addition to the physiologic changes that can occur in the hair follicle during menopause, certain hair disorders, including female-pattern hair loss, telogen effluvium, and frontal fibrosing alopecia, have been noted with higher frequency in post-menopausal women.

Real-World Efficacy and Safety of Cuticapil Stem Hair Serum as an Add-On to Minoxidil in Androgenetic Alopecia: A Prospective Observational Study

BACKGROUND

Androgenetic alopecia (AGA) is a common age-related hair loss condition influenced by genetics and androgen activity.

AIM

This study evaluated the safety and efficacy of Cuticapil Stem Hair Serum in improving hair loss in AGA patients.

METHOD

This multicenter, prospective, observational study assessed the real-world efficacy and safety of Cuticapil Stem Hair Serum in patients with androgenetic alopecia. A total of 60 subjects were evaluated, with the Cuticapil and Standard of Care groups compared using the Mann-Whitney and Wilcoxon signed-rank tests. Key assessments included the hair pull test, global photographic analysis, and hair shedding count. No adverse events were reported, reinforcing the serum's favorable safety profile.

RESULT

The Cuticapil + SoC treatment group consistently showed higher mean ranks across multiple parameters compared to the SoC-only group. The addition of Cuticapil Serum to SoC significantly reduced hair shedding (p = 0.0220). In the Hair Pull Test, the Cuticapil + SoC group had a lower mean rank (26.97) than SoC alone (34.03) (p = 0.0196), indicating greater efficacy. Global photography analysis showed a higher mean rank of 36.13 in the Cuticapil + SoC group compared to 24.87 in the SoC group (p = 0.0057), further supporting its effectiveness.

CONCLUSION

Cuticapil Stem Hair Serum, when used in addition to standard care, significantly enhances hair growth and reduces hair fall in patients with mild to moderate Androgenetic Alopecia and Female Pattern Hair Loss. It showed superior results in promoting hair growth, reducing shedding, improving hair density, appearance, and managing hair loss.

miR-574-3p and miR-125a-5p in Adipose-Derived Mesenchymal Stem Cell Exosomes Synergistically Target TGF-β1/SMAD2 Signaling Pathway for the Treatment of Androgenic Alopecia

Androgenetic alopecia is the most common hair loss disorder, influenced by distinct genetic factors and intricate environmental factors. The exosomes (Exos) from adipose-derived mesenchymal stem cells (ADMSCs) have diverse effects, including the promotion of cell proliferation, inhibition of apoptosis, analgesia, and enhancement of wound healing. MicroRNAs are essential components of the paracrine secretion of ADMSC-derived Exos. This study revealed that ADMSC-derived Exos could counteract the impairment of dermal papilla cells induced by dihydrotestosterone by inhibiting the TGF-β1 signaling pathway`s activation. Two miRNAs-miR-574-3p and miR-125a-5p-were identified as being predominantly expressed and specifically targeting TGF-β1 and SMAD2, respectively. Notably, individually knocking down miR-574-3p or miR-125a-5p did not affect the therapeutic efficacy of ADMSC-derived Exos. Yet, when both miR-574-3p and miR-125a-5p were concurrently knocked down, the efficacy of ADMSC-derived Exos was markedly reduced. Ultimately, our findings indicate that ADMSC-derived Exos target the TGF-β1/SMAD2 signaling pathway through miR-574-3p and miR-125a-5p, which are integral to the therapeutic action of ADMSC-derived Exos on dihydrotestosterone-induced dermal papilla cells and androgenetic alopecia murine models. This discovery offers significant insights into the pathogenesis of androgenetic alopecia and suggests potential therapeutic approaches. Further investigation into the role and interaction of these miRNAs in ADMSC-derived Exos may lead to the development of more precise and efficacious treatments for androgenetic alopecia.

LncRNA H19 inhibited dermal papilla cell senescence process through miR-29a by targeting Wnt/β-catenin signaling pathway

Androgenetic alopecia is a common type of hair loss disease. As the most promising seeder for cell-based therapy, dermal papilla cells are prone to undergo premature senescence during passaging in vitro. Our previous studies revealed high expression of lncRNA H19 in early-passage dermal papilla cells and the maintenance of hair follicle-inducing ability upon prolonged culture. However, the exact mechanism of H19 regulating Wnt signaling pathway related to hair follicle regeneration has not been fully elucidated. Here, a cell senescence model was constructed by continuous cultivation in vitro to investigate the molecular mechanism of H19 in human dermal papilla cells. Animal hair follicle inductivity, cell proliferation and molecular experiments were performed to evaluate the cell inductivity, proliferation, senescence, expression of Wnt signaling key factors in early- and late-passage dermal papilla cells. Ectopic expression and silencing experiments were conducted to estimate effects of H19 on the proliferation and senescence of dermal papilla cells and the possible mechanism. Hair follicles from frontal baldness-prone and occipital non-balding areas of patients with androgenetic alopecia were exploited to detect the expression of H19 and relevant factors. Results showed late-passage DP8 cells exhibited lost hair follicle inductive properties, attenuated cell proliferation, elevated senescent marker and key Wnt factor levels, decreased inducing marker levels. Furthermore, overexpression of H19 inhibited senescence marker expression by binding to SAHH to upregulate miR-29, thus activating the Wnt signaling pathway to maintain inducing ability of DP cells. Knockdown of H19 showed opposite experimental results. Consistently, H19 together with miR-29a levels were lower and the expression levels of miR-29a target genes (DKK1, SFRP2) increased in the dermal papilla cells from frontal baldness-prone and occipital non-balding areas. Conclusively, our data provide a novel insight into the regulation and mechanism of H19 in inhibiting dermal papilla cell senescence, suggesting a potential therapy strategy for androgenetic alopecia.

Analysis on the treatment compliance of patients with androgenetic alopecia and its influencing factors: based on the comparison between microneedle therapy and drug therapy

The aim of this study is to analyze treatment adherence and its influencing factors in patients with androgenetic alopecia (AGA). Clinical data from 156 AGA patients, including 89 males and 67 females, were collected. The patients were assigned to either medication group (n = 86) or microneedling group (n = 70). Treatment adherence was assessed using the Morisky Medication Adherence Scale (MGL). Additional data on the patients' basic information, annual income, education level, side effects, treatment efficacy, disease severity, and mental health (anxiety and depression) were also recorded. Univariate and multivariate analyses were used to identify factors associated with treatment adherence. The results showed that patients in the microneedling group demonstrated significantly higher treatment adherence compared to those in the medication group (P = 0.032). Within the microneedling group, adherence was significantly associated with age, education level, annual income, treatment duration, and side effects (P < 0.05). Specifically, patients over the age of 30, those with higher incomes, higher educational levels, and those with treatment durations of less than 3 months exhibited better adherence. Additionally, both treatment efficacy improvement and reduced anxiety were strongly correlated with better adherence (P < 0.001, P = 0.010). In the medication group, side effects and treatment efficacy were significant factors influencing adherence (P = 0.001, P < 0.001). Logistic regression analysis revealed that, within the microneedling group, patients with at least a middle school education or higher (OR = 0.031, P = 0.035; OR = 0.016, P = 0.041) and those who experienced improved treatment outcomes (OR = 0.002, P = 0.006) were more likely to adhere to treatment. On the other hand, the occurrence of side effects significantly increased the likelihood of non-adherence (OR = 92.358, P = 0.019). Patients with more severe conditions were more likely to adhere to treatment (OR = 0.035, P = 0.038). In the medication group, those with stable or improved treatment outcomes showed better adherence (OR = 0.004, P = 0.010; OR = 0.005, P = 0.012). However, patients with more severe conditions were more likely to discontinue treatment (OR = 204.058, P = 0.029), and depression was identified as a significant risk factor for non-adherence (OR = 586.074, P = 0.004). Microneedling therapy demonstrates significant advantages in improving patient adherence, particularly by reducing side effects, enhancing perceived treatment efficacy, and improving mental health. Treatment efficacy and side effects are key determinants of treatment adherence, with patient age, education level, and income also playing an important role. Future studies should further explore the long-term efficacy and safety of microneedling therapy across different patient populations to optimize treatment protocols and improve adherence.

Platelet-rich plasma for androgenetic alopecia: intradermal injection or microneedle delivery?

OBJECTIVE

This study compared the clinical effectiveness of two methods of platelet-rich plasma (PRP) administration for treating androgenetic alopecia (AGA): microneedle delivery and intradermal injection. The study also evaluated adverse reactions associated with both methods.

PATIENTS AND METHODS

Twenty patients with AGA were selected according to specific inclusion and exclusion criteria. The scalp of each patient was divided into two treatment areas along the midline, each randomly assigned to receive PRP either via intradermal injection (n = 20) or microneedle delivery (n = 20). The treatment comprised three sessions spaced 1 month apart. Scalp photographs and trichoscopic measurements were obtained before the first session and 6 month after the final session. Patient outcomes were assessed 6 month after the last treatment using the Global Aesthetic Improvement Scale and a self-satisfaction questionnaire. Pain levels during the first session were measured using a Numerical Rating Scale, and adverse reactions were recorded throughout the study.

RESULTS

Six month after completing all treatments, no significant differences were observed between the microneedle delivery and intradermal injection groups for hair density, hair diameter, single hair follicle ratio, or trichoscopic findings (p > .05). However, the microneedle group reported significantly lower pain levels than the intradermal injection group (p < .001). No adverse events were observed during the treatment period.

CONCLUSION

The clinical efficacy of microneedle delivery of PRP was comparable to that of intradermal injection for AGA treatment, with the added benefit of significantly lower pain levels. This suggests that microneedle delivery may be a promising alternative for AGA management.

Efficacy, safety and tolerability of drugs for alopecia: a comprehensive review

INTRODUCTION

Alopecia, encompassing non-scarring and scarring types, presents therapeutic challenges requiring individualized approaches based on pathophysiology and treatment responses. A comprehensive literature search of PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science (2015-2024) focused on randomized controlled trials, meta-analyses, and observational studies.

AREAS COVERED

This review evaluates pharmacological strategies for androgenetic alopecia (AGA), alopecia areata (AA), and scarring alopecias, emphasizing efficacy and safety. Treatments for non-scarring alopecia include finasteride, minoxidil, JAK inhibitors, and antiandrogens like spironolactone. JAK inhibitors, such as baricitinib, show promise for AA but require monitoring due to immune suppression risks. Scarring alopecias, including lichen planopilaris and discoid lupus erythematosus, are managed with systemic agents like hydroxychloroquine and corticosteroids, alongside adjunctive topical and laser therapies.

EXPERT OPINION

The future of alopecia treatment is poised for transformation, particularly for AA and AGA. Emerging targeted therapies, such as JAK inhibitors for AA, represent significant advancements. Additionally, innovations in regenerative medicine and delivery systems for AGA treatments, alongside nanotechnology and 3D bioprinting, promise enhanced efficacy and personalization. This shift toward mechanism-targeted and individualized therapy is expected to improve outcomes for various alopecia subtypes.

Jiawei Erzhiwan Ameliorates Androgenetic Alopecia by Regulating the SIRT1/JNK/p38 MAPK Pathway

Purpose

Androgenetic alopecia (AGA) is a type of hair loss. Our previous study showed AGA ameliorating capability of water extract of an herbal prescription, "Jiawei Erzhiwan" (WJWE), which was derived from the traditional formula "Erzhiwan". However, the underlying mechanisms is still unknown.

Patients and Methods

In this study, the phytochemical ingredients in WJWE were characterized via UPLC‒MS/MS analysis. The dihydrotestosterone (DHT)-induced murine model and dermal papilla cells (DPCs) assays were used to evaluate and elucidate the beneficial effects and mechanisms of WJWE on AGA.

Results

WJWE promoted hair growth and hair follicle regeneration in AGA mice, improved DPCs growth and dose-dependently protected DHT-reduced DPCs viability in vitro by stimulating the Wnt5A/β-Catenin pathway. Additionally, WJWE reduced DHT-induced oxidative stress in AGA model murine skin and DHT-treated DPCs. To elucidate the regulative mechanism, we found that WJWE treatment significantly and dose-dependently increased the expression of SIRT1 and reduced the phosphorylation of JNK and p38 MAPK in both DHT-treated DPCs and AGA model mice. And the application of EX527 (a SIRT1 inhibitor) could the effect of WJWE.

Conclusion

Our study provided some evidence of WJWE on AGA treatment, by which SIRT1/JNK/p38 MAPK signaling pathway might be the major target.

Construction of Large-Scale Bioengineered Hair Germs and In Vivo Transplantation

Hair follicle (HF) regeneration technology holds promise for treating hair loss, but creating a biomimetic structure that mimics the natural follicle microenvironment remains challenging. Here a novel bioengineered hair germ (BHG) is developed using thermodynamically incompatible mucopolysaccharides to enhance HF regeneration efficiency. Mucopolysaccharide-based hydrogels are synthesized by grafting amino and diethylamino groups (dihydroxyphenylalanine-grafted hyaluronic acid (HME) hydrogels) for rapid gelation and strong wetting adhesion. Dual-layered microspheres are fabricated using a co-flow microfluidic system, with HME as the outer shell and gelatin methacrylate (GelMA) as the core, achieving thermodynamic incompatibility. The Wnt3a protein is encapsulated for sustained release. RNA sequencing, reverse transcription quantitative polymerase chain reaction (RT-qPCR), and functional validation are used to study the molecular mechanisms of HF regeneration. Results show that HME hydrogels exhibit excellent adhesion, shear-thinning behavior, and biocompatibility. The microspheres release Wnt3a for up to 9 days, with high-throughput sequencing revealing upregulation of HF regeneration genes like Ctnnb1 and Lef1, and activation of the Wnt signaling pathway, while hypoxia-related genes such as Hif-1ɑ are downregulated. Pathway enrichment analyses confirm the enrichment of HF regeneration pathways. In conclusion, the HME-based BHG microspheres effectively promote in vivo HF regeneration, offering a promising solution for hair loss treatment and regeneration.

Comprehensive Review on Hair Loss and Restorative Techniques: Advances in Diagnostic, Artistry, and Surgical Innovation

Hair loss, or alopecia, is a complex disorder that impacts individuals worldwide, frequently resulting in significant psychological and social consequences. This review analyzes the multifactorial etiology, recent diagnostic innovations, and emerging treatment alternatives for hair loss management. Alopecia is classified into the cicatricial (scarring) and non-cicatricial (non-scarring) forms, each having a unique underlying pathogenesis, ranging from autoimmune dysregulation, androgenetic mechanisms, and environmental factors. Recent advancements in diagnostics, such as artificial intelligence (AI)-enhanced imaging and biomarker analysis, have improved precision and individualization of treatment. Novel therapies, such as low-dose oral minoxidil (LDOM), topical 5-alpha reductase inhibitors, and Janus kinase inhibitors (JAKi), offer a range of promising options for hair loss management. Non-invasive therapies, such as low-level laser therapy (LLLT) and platelet-rich plasma (PRP) injections, have demonstrated synergistic benefits with existing treatments. Surgical advancements, especially AI-assisted robotic follicular unit extraction (FUE), enhance precision and outcomes. Emerging trends in regenerative medicine, especially stem-cell-based therapies and AI integration, are influencing the future of customized hair restoration. This review serves as a comprehensive guide, highlighting the use of innovative technologies and therapies in enhancing the accuracy and customization of hair loss treatment.

Innovative strategies for the discovery of new drugs against androgenetic alopecia

INTRODUCTION

Androgenetic alopecia (AGA) is the most common cause of hair loss worldwide. The significant psychological and social impact of AGA continues to drive demand for more effective treatments beyond the limited options currently available.

AREAS COVERED

The authors review the key components of AGA pathogenesis, as well as current treatments, and therapeutic techniques under development. Innovative strategies for AGA drug discovery are still needed, given the significant unmet medical needs and the limited efficacy of both current and emerging treatments. The authors outline relevant preclinical models, such as hair follicle (HF) cell cultures, 3D spheroids, organoids, follicle explants, and animal models, highlighting their advantages and limitations in AGA research. Finally, they summarize the primary objectives in AGA treatment development, including direct hair growth promotion, interference with androgen signaling, and HF rejuvenation, identifying key pathogenesis intervention points for treatment development.

EXPERT OPINION

Developing better in vitro models, possibly using induced pluripotent stem cell (iPSC) systems, could greatly accelerate drug discovery. Similarly, a superior in vivo model could significantly expedite drug discovery. Near future development research should focus on drug delivery improvements. Longer term, treatments targeting AGA's underlying pathophysiology and promoting HF rejuvenation or true regeneration would provide the most benefit to prospective patients.

Can oral minoxidil be the game changer in androgenetic alopecia? A comprehensive review and meta-analysis comparing topical and oral minoxidil for treating androgenetic alopecia

Androgenetic alopecia (AGA) is a hair disorder seen in both sexes. Its aetiology is multifactorial. Treating AGA has always been a challenge for dermatologists. Only a few drugs such as topical minoxidil and finasteride are U.S. Food and Drug Administration-approved for treating AGA. Thus, looking for new and more effective treatment options for AGA is imperative. This review was conducted to compare the efficacy of oral with topical minoxidil in treating AGA. Only clinical trials that compared oral with topical minoxidil in treating AGA were included in this review. PubMed, Cochrane, Scopus and ClinicalTrials.gov were searched. A total of 2063 studies were retrieved from the databases. Four studies met the inclusion criteria and were included in this systematic review. Outcomes such as hair density, terminal hair density, hair count, global photographic assessment and negative hair pull were studied in this review. The results showed that there was no significant difference between oral and topical minoxidil in terms of improving the hair density of patients with AGA (overall mean difference 0.95, 95% confidence interval -24.98 to 26.87). Two studies showed that the mean difference in terminal hair density was greater in patients treated with oral minoxidil, but there was no significant difference between the two treatments in terms of improving terminal hair density. The efficacy of oral minoxidil is comparable to that of topical minoxidil in terms of improving hair density and terminal hair density in patients with AGA. Oral minoxidil can be used as an adjunct or as a second-line treatment option for AGA.

Kyoh® Rocket Leaf Extract Regulates Proliferation and VEGF and FGF7 Expression in Human Dermal Follicle Papilla Cells

Androgenetic alopecia is the most common cause of hair loss for women and men. Current treatments for androgenetic alopecia, such as those based on drugs like Minoxidil, Finasteride, or Dutasteride, have been associated with a variety of side effects, such as irritation, contact dermatitis, scalp pruritus, burning, etc. In this regard, plant extracts have emerged as promising alternatives to available chemical-based treatments for androgenetic alopecia given their efficacy, customer acceptability, and potentially minimized side effects. In this study, we evaluated the efficacy of Kyoh®, an extract from rocket leaves, as a treatment to improve the signs of androgenetic alopecia. We found that Kyoh® contained 2.1% total flavonoids, with kaempferol, quercetin, and isorhamnetin diglucosides being the most abundant. Additionally, Kyoh® showed a stimulating effect on the growth of human dermal follicle papilla cells in laboratory conditions. Most importantly, Kyoh® enhanced the gene expression of the hair growth-associated growth factors VEGF (Vascular Endothelial Growth Factor) and FGF7 (Fibroblast Growth Factor 7). Specifically, VEGF expression increased by 60.7% after 4 h and 267.3% after 24 h, while FGF7 expression increased by 50.3% after 4 h and 244.3% after 24 h, indicating both a rapid induction of gene expression and a sustained effect lasting at least one day. Moreover, Kyoh® increased the gene expression of NRF2 (Nuclear factor erythroid 2-related factor 2) by 71.2%, which encodes for a protein participating in the antioxidant response. Overall, our study shows that flavonol-rich rocket extract (Kyoh®) is a promising treatment for promoting hair growth, demonstrated by its proliferation-promoting effect, potential antioxidant priming, and induction of the expression of growth factors associated with hair growth and health.

Mesenchymal stem cell exosomes enhance the development of hair follicle to ameliorate androgenetic alopecia

BACKGROUND

Mesenchymal stem cells (MSCs) and their secretome have significant potential in promoting hair follicle development. However, the effects of MSC therapy have been reported to vary due to their heterogeneous characteristics. Different sources of MSCs or culture systems may cause heterogeneity of exosomes.

AIM

To define the potential of human adipose-derived MSC exosomes (hADSC-Exos) and human umbilical cord-derived MSC exosomes (hUCMSC-Exos) for improving dermal papillary cell proliferation in androgenetic alopecia.

METHODS

We conducted liquid chromatography-mass spectrometry proteomic analysis of hADSC-Exos and hUCMSC-Exos. Liquid chromatography-mass spectrometry suggested that hADSC-Exos were related to metabolism and immunity. Additionally, the hADSC-Exo proteins regulated the cell cycle and other 9 functional groups.

RESULTS

We verified that hADSC-Exos inhibited glycogen synthase kinase-3β expression by activating the Wnt/β-catenin signaling pathway via cell division cycle protein 42, and enhanced dermal papillary cell proliferation and migration. Excess dihydrotestosterone caused androgenetic alopecia by shortening the hair follicle growth phase, but hADSC-Exos reversed these effects.

CONCLUSION

This study indicated that hair development is influenced by hADSC-Exo-mediated cell-to-cell communication via the Wnt/β-catenin pathway.

Multidimensional assessment of adverse events of finasteride：a real-world pharmacovigilance analysis based on FDA Adverse Event Reporting System (FAERS) from 2004 to April 2024

BACKGROUND

Finasteride is commonly utilized in clinical practice for treating androgenetic alopecia, but real-world data regarding the long-term safety of its 0adverse events(AEs) remains incomplete, necessitating ongoing supplementation. This study aims to evaluate the AEs associated with finasteride use, based on data from the US Food and Drug Administration Adverse Event Reporting System (FAERS), to contribute to its safety assessment.

METHODS

We reviewed AE reports associated with finasteride from the US Food and Drug Administration Adverse Event Reporting System database, covering the period from the first quarter of 2004 to the first quarter of 2024. We assessed the safety of finasteride medication and AEs using four proportional disproportionality analyses: reported odds ratio (ROR), proportionate reporting ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPN), and Multi-Item Gamma Poisson Shrinkage (MGPS). These methods were used to evaluate whether there is a significant association between finasteride drug use and AEs. To investigate potential safety issues related to drug use, we further analyzed the similarities and differences in the onset time and AEs by sex, as well as the similarities and differences in AEs by age.

RESULTS

A total of 11,557 AE reports in which finasteride was the primary suspected drug were analysed. The majority of patients were male (86.04%) and a significant proportion were young adults aged 18-45 years (27.22%). A total of 73 different AEs were categorised into 7 system organ classes (SOCs), with common AEs including erectile dysfunction and sexual dysfunction. In addition, we identified previously unlisted AEs, including Peyronie's disease and post-5α reductase inhibitor syndrome. Of the reported AEs, 102 occurred in men and 7 in women, with depression and anxiety being significant AEs observed in both sexes. When analysed by age group, there were 17 AEs in patients aged ≤ 18 years, 157 in patients aged 18-65 years and 133 in patients aged ≥ 65 years. Common AEs in all age groups included erectile dysfunction, decreased libido, depression, suicidal ideation, psychotic disturbances and attention disorders. The median time to onset of all AEs was 61 days, with the majority occurring within the first month of treatment. Notably, a significant number of AEs persisted beyond one year of treatment.

CONCLUSION

The results of our study uncovered both known and novel AEs associated with finasteride medication. Some of these AEs were identical to the specification, and some of them signaled AEs that were not demonstrated in the specification. In addition, some AEs showed variations based on sex and age in our study. Consequently, our findings offer valuable insights for future research on the safety of finasteride medication and are anticipated to enhance its safe use in clinical practice.

Efficacy and safety of topical finasteride spray solution in the treatment of Chinese men with androgenetic alopecia: A phase III, multicenter, randomized, double-blind, placebo-controlled study

BACKGROUND

Topical finasteride is a novel treatment for men with an androgenetic alopecia (AGA). This study aimed to evaluate the efficacy and safety of topical finasteride spray solution in Chinese men with AGA.

METHODS

This randomized, double-blind, placebo-controlled, phase III trial enrolled 270 individuals with AGA from 16 sites across China between December 2021 and March 2023. The participants were randomized at a ratio of 2:1 to receive either topical finasteride or placebo treatment once daily for 24 weeks. The primary endpoint was the change from baseline in target area (0.903 cm2 area) hair count at week 24. The secondary endpoints were change from baseline in target area hair count at week 12, target area terminal hair count at weeks 12 and 24, target area terminal hair width at week 24, and target area hair width at week 24; an improvement of vertex hair growth assessed by the investigator at week 24; and the patient-assessed scores on the Male Hair Growth Questionnaire at week 24.

RESULTS

A total of 270 individuals were enrolled and randomized and 251 completed the study. Compared with the placebo group, in the topical finasteride group, the change from baseline in target area hair count was significantly higher at week 24 (P <0.05), although it was only numerically higher at week 12 (P = 0.0688). Significant differences favoring topical finasteride over placebo were observed for change from baseline in target area terminal hair count at weeks 12 (P <0.05) and 24 (P <0.01). The improvement of vertex hair growth assessed by the investigator was significantly greater in the topical finasteride group vs. the placebo group at week 24 (P <0.01). Topical finasteride was generally safe and well-tolerated.

CONCLUSIONS

In Chinese men with AGA, topical finasteride spray solution increased hair growth and showed good safety and tolerability profile during a 24-week treatment period.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT05135468.

Assessment of androgenic hormones and other risk factors in Egyptian males with early onset androgenetic alopecia: a case control study

Early-onset androgenetic alopecia (AGA) is a common, hereditary hair loss condition in men, often starting in the early twenties. It involves gradual thinning of hair, influenced by genetics, hormones, and other factors like smoking and family history. Early identification of these risks could support timely intervention. This case control study aimed to evaluate androgen levels, specifically the free androgen index(FAI) and dehydroepiandrosterone sulfate ( DHEA-S), in males with early-onset AGA versus healthy age and sex matched controls. It also determined risk factors contributing to premature AGA in Egyptian males. This study included 40 male patients between 18 and 30 years with early-onset AGA and 40 age-matched healthy male controls. Risk factors and hormonal profiles including sex hormone binding globulin (SHBG), total testosterone (TS), DHEA-S as well as calculated FAI were compared between both groups using ELISA kit. Our study found that early-onset AGA is linked to a strong family history, smoking, coffee intake, hair straightener use, fast-food diets, and recent weight gain. Early-onset AGA patients also showed statistically significant lower SHBG levels and higher TS, DHEAS and FAI compared to healthy controls. These findings suggest that early-onset AGA is shaped by a complex interaction of different factors, highlighting the importance of a comprehensive approach and advice to patients as regards different risk factors.

Gas-propelled anti-hair follicle aging microneedle patch for the treatment of androgenetic alopecia

Existing treatments for androgenetic alopecia (AGA) are unsatisfactory, owing to the two major reasons: (1) Oxidative stress and vascularization deficiency in the perifollicular microenvironment provoke the premature senescence of hair follicles, limiting the transformation of hair growth cycle from the telogen to the anagen phase; (2) The amount of drug delivered to the perifollicular region located in the deep dermis is very limited for passive drug delivery systems. Herein, we developed a gas-propelled microneedle patch integrated with ferrum-chelated puerarin/quercetin nanoparticles (PQFN) to increase drug accumulation in hair follicles and reshape the perifollicular microenvironment for improved hair-regenerating effects. PQFN can rejuvenate testosterone (Tes)-induced senescence of dermal papilla cells by scavenging ROS, restoring mitochondrial function, regulating signaling pathways related to hair regeneration, and upregulating hair growth-promoting genes. PQFN more efficiently promoted endothelial cell proliferation, migration, and tube formation than ferrum-chelated quercetin nanoparticles (QFN) because of puerarin's proangiogenic effects. Compared with passive MNs, gas-propelled MNs promoted drug diffusion and permeation into deeper skin layers, resulting in significantly higher drug accumulation in hair follicles. Pharmacodynamic studies on an AGA mouse model further showed that PQFN-loaded active MNs achieved higher hair coverage by alleviating oxidative stress, promoting angiogenesis, and rejuvenating senescent cells. Therefore, this study presents a novel "anti-hair follicle aging" treatment strategy for AGA.

Natural phenylethanoid glycoside forsythoside A alleviates androgenetic alopecia by selectively inhibiting TRPV3 channels in mice

Dihydrotestosterone (DHT), an androgen derivate, is known to be a key factor involved in androgenetic alopecia. DHT suppresses the growth of outer root sheath cells and induces apoptosis of hair keratinocytes, thereby causing hair follicle miniaturization and hair regrowth inhibition. Forsythoside A, a natural substance derived from Forsythia suspensa, has been shown to reduce DHT-induced apoptosis in human hair cells and suppress hair regrowth inhibition induced by DHT in mice. However, the molecular mechanism underlying the action of forsythoside A remains unclear. Here, we report that the alleviation of androgenetic alopecia by natural phenylethanoid glycoside forsythiaside A involves the selective inhibition of warmth-sensitive Ca2+-permeable transient receptor potential vanilloid-3 (TRPV3) channels. TRPV3 mRNA and protein expressions are upregulated in the skin of a mouse model of androgenetic alopecia induced by DHT. Ablation of the Trpv3 gene or subcutaneous injection of forsythoside A alleviates DHT-induced hair regrowth inhibition. In whole-cell patch clamp recordings, forsythoside A selectively inhibits macroscopic TRPV3 currents in a concentration-dependent manner with an IC50 value of 40.1 ± 4.8 μM. At the single-channel level, forsythoside A also reduces the channel open probability and open frequency without significantly altering the channel unitary conductance. Molecular docking combined with site-directed mutagenesis reveals two residues T636 and T665 critical for forsythoside A-mediated inhibition of TRPV3. Taken together, our findings demonstrate that TRPV3 inhibition is an important a mechanism by which natural forsythoside A ameliorates DHT-induced hair regrowth. Topical TRPV3 inhibitors may hold promise as a new therapeutic approach for treating androgenetic alopecia.

Local Injection versus Topical Microneedling of Platelet-Rich Plasma for Androgenetic Alopecia: A Systematic Review

Autologous platelet-rich plasma (PRP) has gained popularity for hair restoration due to its effectiveness and safety. PRP could be administered through direct local injections to the scalp or applied topically with the aid of microneedling therapy. This systematic review aims to elaborate on the effectiveness of PRP administered with syringe injection and topical PRP with microneedling combination for the treatment of androgenetic alopecia (AGA). A literature search was employed through PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, and Scopus. The database was searched using terms and keywords: "platelet-rich plasma" and "microneedling" and "androgenetic alopecia." Inclusion criteria are human study, patients with AGA, studies that compare PRP with syringe injection and the combination of PRP and microneedling. Exclusion criteria are animal study, review, case reports, or studies on other form of alopecia. A total of 108 articles found in the database. Title and abstract screening yield 12 articles. After full-text reading three articles were included in the review. A combination of PRP and microneedling appears to yield more superior results than direct syringe injection. Topical PRP and microneedling potentially give better results on AGA cases. Further high-quality studies with uniform protocol are needed to confirm these findings. Level of Evidence  I.

Efficacy and safety of oral minoxidil versus topical solution in androgenetic alopecia: a meta-analysis of randomized clinical trials

The benefits and potential risks of oral minoxidil therapy versus topical minoxidil therapy in patients with androgenetic alopecia (AGA) are controversial. We systematically searched PubMed, Embase, and Cochrane for randomized clinical trials (RCTs) comparing the use of oral minoxidil and minoxidil topical solution in patients with AGA. Statistical analyses were performed using R Studio 4.3.2. Standard mean difference (SMD) and risk ratio (RR) with 95% confidence intervals (CI) were pooled across trials. This meta-analysis included four RCTs reporting data on 279 patients. Follow-up ranged from 24 to 39 weeks. There were no differences in hair density (SMD 0.02; 95% CI -0.25 to 0.29; P = 0.88; I2 = 0%) or hair diameter (SMD -0.25; 95% CI -0.75 to 0.26; P = 0.34; I2 = 36%). The incidence of hypertrichosis was statistically significantly higher in the oral minoxidil group when compared to the topical minoxidil group (RR 2.01; 95% CI 1.18-3.41; P = 0.01; I2 = 0%). There was no statistically significant difference between groups for the incidence of hypotension (RR 2.42; 95% CI 0.26-22.46; P = 0.44; I2 = 0%). In patients with AGA, oral minoxidil and minoxidil topical solution have similar efficacy and safety, with equivalent improvements in hair density, hair diameter, and incidence of adverse events, such as hypotension.

Human-Centric, Three Dimensional Micro Light-Emitting Diodes for Cosmetic and Medical Phototherapy

Phototherapy based on micro light-emitting diodes (µLEDs) has gained enormous attention in the medical field as a patient-friendly therapeutic method due to its advantages of minimal invasiveness, fewer side effects, and versatile device form factors with high stability in biological environment. Effective cosmetic and medical phototherapy depends on deep light penetration, precise irradiation, and simultaneous multi-site stimulation, facilitated by three-dimensional (3D) optoelectronics specifically designed for complex human matters, defined here as 3D µLEDs. This perspective article aims to present the functionalities and strategies of 3D µLEDs for human-centric phototherapy. This study investigates the effectiveness of phototherapy enabled by three key functionalities such as shape morphing, self-adaptation, and multilayered spatiotemporal mapping of 3D µLEDs. Finally, this article provides future insights of 3D µLEDs for human-centric phototherapy applications.

Epidemiological landscape of androgenetic alopecia in the US: An All of Us cross-sectional study

BACKGROUND

Androgenetic alopecia (AGA) is extremely prevalent with a multifactorial etiology.

MATERIALS

We conducted a cross-sectional study using the All of US (AoU) dataset Sept 2024 to better understand the epidemiology, social determinants and management of AGA.

RESULTS

Most males were 20-39 years old and females 60-69 years old. Men typically have an earlier onset of AGA than females. Male AGA is generally managed with finasteride; oral minoxidil is prescribed in younger males. Females are prescribed spironolactone and oral minoxidil with finasteride in post-menopausal females. There was very little dutasteride prescribed. Topical minoxidil is available over the counter and was not evaluated. Early in 2011 there were reports of the Post-Finasteride Syndrome (PFS); subsequently, the finasteride prescription rate fell to about 10-20% of the pre-PFS prescription rate. There was increased reporting for AGA in those who drink, have an annual household income ≥$75,000, and those with a higher level of education. There was also higher reporting of female AGA in those with anxiety and depression. Patients with higher income and education may have less pressing medical concerns enabling them to bring their AGA to the physician's attention. Females in whom the AGA affects their anxiety and depression may seek help for the AGA as a way to address their underlying disorder.

CONCLUSIONS

This study provides a snapshot of the epidemiology and management of AGA in the USA. AGA is linked to the social determinants of health; addressing the AGA may help better manage the underlying mental and physical state.

Black phosphorus nanosheets encapsulated microneedle for multifunctional therapy for androgenic alopecia

BACKGROUND

Androgenetic alopecia (AGA), a chronic and progressive disease, significantly impacts the patients' social, emotional, and mental well-being. Current treatment for AGA are mainly limited by drug side effects and the stratum corneum (SC) barrier of scalp.

RESULTS

To address these issues, we developed a microneedle (MN) system loaded with black phosphorus nanosheets (BP) encapsulating baicalin (BA), a natural ingredient, for effective treatment of AGA. We first fabricated BP-BA based on the BP properties of high drug loading capacity and excellent photothermal conversion efficiency. Upon 635 nm laser irradiation, BP-BA demonstrated efficient photothermal conversion to mild thermal of ~ 42 °C. This mild thermal effect controlled BA's stimuli-responsive release, enhanced cellular uptake, and effectively modulated gene expression in dihydrotestosterone-treated human dermal papilla cells, downregulating negative regulators such as SRD5A2, AR, DKK1, and TGFB1, while upregulating positive regulators like CTNNBIP1 and VEGFA. Furthermore, we encapsulated BP-BA to MN fabricating BP-BA@MNs to overcome the SC barrier. Compared with BP-BA@MNs without laser irradiation, BP-BA@MNs with laser irradiation significantly enhanced drug penetration into the subcutaneous area and accumulation at the follicular site. Importantly, BP-BA@MNs demonstrated synergistic efficacy against testosterone-induced AGA in vivo through combining BA chemotherapy, BP-mediated mild photothermal therapy, and MN delivery, as well as good biocompatibility and biosafety, and the underlying synergistic mechanism was elucidated in terms of follicular microenvironment reconstruction.

CONCLUSIONS

This combining BP mild photothermal and MN system is a promising approach for follicular targeted drug delivery, providing a multifunctional strategy for addressing the clinical needs of anti-AGA.

New tool in our arsenal: efficacy of injectable platelet-rich fibrin (i-PRF) in androgenetic alopecia treatment

OBJECTIVE

This study assesses the short-term therapeutic efficacy and safety of injectable platelet-rich fibrin (i-PRF) in managing androgenetic alopecia (AGA). AGA, a common genetic condition leading to hair loss, significantly affects the quality of life. Given the limited efficacy of existing treatments, there is an urgent need for novel therapeutic strategies. This study investigates the potential of i-PRF, a biotherapeutic agent enriched with growth factors and cell proliferation promoters, to enhance hair regeneration and ameliorate the microenvironment of hair follicles.

METHODS

A prospective, single-center study enrolled 30 AGA patients with inadequate responses to conventional treatments. Participants received six monthly i-PRF injections. Assessments included hair scoring (hair density, vellus hair percentage, and hair shaft diameter), treatment efficacy, physician's visual subjective scoring, scalp inflammation scoring (folliculitis, greasiness, dandruff, and itching), Dermatology Quality of Life Index (DLQI) scores, patient satisfaction scoring, and monitoring for adverse reactions post-injection.

RESULTS

At the 6-month mark, an 80% response rate was achieved, with significant improvements in hair loss and scalp symptoms as per hair scoring, physician's visual subjective scoring, scalp inflammation scoring, DLQI scoring, and patient satisfaction scoring compared to baseline.

CONCLUSION

i-PRF effectively enhances hair density and alleviates scalp symptoms in AGA patients, demonstrating notable therapeutic effects with minimal adverse reactions, offering a promising new avenue for AGA treatment.

Assessing Causality Between Androgenetic Alopecia with Depression: A Bidirectional Mendelian Randomization Study

Background

Androgenetic alopecia (AGA) is the most common form of alopecia globally, which exerts a negative impact on patients' self-esteem and overall quality of life. Previous observational studies have found a significant increase in the prevalence of depression in AGA patients, but the causal relationship remains to be elucidated.

Methods

In this study, we conducted a bidirectional Mendelian randomization (MR) using genome-wide association studies (GWAS) datasets. The available GWAS dataset of AGA was obtained from the Neale Lab consortium (n=154988). The dataset for depression was obtained from the ebi-a-GCST90038650 (n=484598). The main analysis method for determining the causal link between AGA and depression was inverse variance weighted (IVW). Subsequently, pleiotropy and heterogeneity tests were performed to determine the reliability of the results.

Results

Utilizing the IVW method, depression does not significantly contribute to the incidence of AGA (IVW odds ratio [OR] = 1.101, 95% confidence interval [CI] =0.890-1.362, P = 0.374). Conversely, the data suggested a statistically significant association where AGA may precipitate the development of depression, with a notable increase in risk (IVW OR = 1.015, 95% CI = 1.002-1.029, P = 0.020).

Conclusion

We are the first to use MR analysis to explore the causal relationship between AGA and depression, revealing an increased risk of depression in individuals with AGA.

Application of platelet-rich plasma lysate combined with hyaluronic acid microneedles for the treatment of alopecia

Androgenetic alopecia (AGA) continues to pose a significant challenge due to the paucity of effective therapeutic options. Upon lysis, platelet-rich plasma (PRP) releases numerous growth factors (GFs), which facilitate tissue reconstruction and hair regeneration. However, concerns such as infection, bleeding, local erythema, and patient anxiety associated with injections have substantially diminished patient acceptance. To address these issues, we developed a microneedle (MN) system loaded with PRP lysate (PL), termed PL-MN, designed to deliver GFs transdermal to sites of hair loss without inducing significant discomfort. The PL-MN not only exhibits a well-defined needle structure but also demonstrates excellent in vivo penetration and external transdermal efficacy. Upon skin penetration, the needle matrix rapidly dissolves, releasing GFs directly to the target site. In animal tests, the PL-MN shows synergistic effects by orchestrating an upregulation in the expression of Ki67 and CD31, which collectively foster cell proliferation and migration, thereby facilitating the expedited progression of hair follicles (HFs) into the anagen phase and promoting peripheral angiogenesis. Compared with minoxidil, the first-line clinical drug for treating AGA (administered once per day, 20 times in total), the PL-loaded MN could induce hair regeneration in mice with a lower frequency of administration (once every 3 days, 5 times in total). Consequently, such a safe and GFs-releasing MNs patch shows great potential for clinical AGA treatment.

Modulating metal-organic frameworks by surface engineering of stearic acid modification for follicular drug delivery and enhanced hair growth promotion

Cyclodextrin metal-organic frameworks (CD-MOF) as delivery carriers have gained great attention in the biomedical field. However, limited by challenges of moisture-sensitive nature, the design and application of CD-MOF-based hair follicle delivery for androgenic alopecia (AGA) has rarely been explored. We developed the metal-organic frameworks as hair follicle-targeted delivery system (SA-MOF), stearic acid (SA) was used to modify metal-organic frameworks to form a protective hydrophobic layer on the surface and provide the additional hair growth-promoting effect. Cardamonin (CAR), a newly discovered biosafety natural product, was encapsulated in SA-MOF (CAR@SA-MOF) to promote the therapeutic efficacy on AGA. CD-MOF surface-engineered nanoparticles modified by SA avoided the rapid hydration and disintegration of CD-MOF in water, which improved the drug release and follicular deposition of drug. Assisted by the delivery of SA-modified CD-MOF carriers, the drug significantly promoted cell proliferation and migration, achieving the promoting effect on hair follicle differentiation and hair regeneration in testosterone-challenged C57BL/6 mice. Simultaneously, SA modification provided additional promoting effects on human dermal papilla cell proliferation, regulating effect on keratinocyte growth factor, and activating effect of key signaling pathways. The surface engineering design of CD-MOF hair follicle drug delivery based on SA modification exhibits significant potential for the treatment of hair follicle and sebaceous gland-related diseases.

Assessing the safety of topical minoxidil through disproportionality analysis of FAERS reports

BACKGROUND

Topical minoxidil, approved by the FDA in the 1980s, has been widely used to manage androgenetic alopecia. While effective, several adverse events (AEs) related to its use, especially those not well-documented on product labels, remain a concern.

OBJECTIVE

This study aimed to evaluate the safety of topical minoxidil by analyzing AEs reported in the FDA Adverse Event Reporting System (FAERS) from 2004 to 2024, focusing on identifying potential risk signals not highlighted on current product labels.

METHODS

Adverse event reports (AERs) from FAERS, where topical minoxidil was identified as the primary suspect, were analyzed. Disproportionality analysis methods, Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-Item Gamma Poisson Shrinker (MGPS), were used to assess the relationship between minoxidil and reported AEs.

RESULTS

Among 45,130 reports, most were from males (50.88%) and showed a significant increase in incidents since 2015. Newly identified AEs, such as application site acne and cysts, were observed. These AEs are not well represented on product labels.

CONCLUSION

The study identified previously unreported AEs linked to topical minoxidil, underscoring the need for updated patient information and regulatory reassessment to enhance safety and inform clinical practices.

Polynucleotides as a novel therapeutic approach in androgenetic alopecia: an analysis of effectiveness and safety

Androgenetic alopecia (AGA) is a highly prevalent condition that poses a significant challenge to quality of life, yet the US Food and Drug Administration-approved treatments remain limited. Polynucleotides (PN) stimulate tissue regeneration by reducing inflammation, activation of growth factors and accelerating angiogenesis, which are vital for hair regrowth. This study aimed to assess the efficacy of PN in promoting hair regrowth by measuring changes in hair diameter and density in patients with AGA. This prospective study evaluated 28 patients with AGA who received four injection of DOT™ PN (DNA Fragment Optimizing Technology Polynucleotides) at four-week intervals. Hair diameter and density were quantitatively assessed using dermoscopic analysis. Treatment efficacy was also evaluated using patient and dermatologist satisfaction survey. Both hair diameter and density showed significant improvement, with hair diameter increased notably one month post-treatment and continuing to rise throughout the study. Total hair density improvements were evident from one months post-treatment onwards. Additionally, the dermatologist's assessment indicated stabilization in 60.7% of cases, while the patient assessment score indicated improvement in 82.1% of cases, with no serious side effects. This study demonstrates that PN effectively promotes hair regrowth in AGA patients. This is likely due to increased angiogenesis and anti-apoptotic effects. PN offers a promising new alternative for patients who have not responded to traditional treatments.

Unhealthy diet and lifestyle factors linked to female androgenetic alopecia: a community-based study from Jidong study, China

BACKGROUND

To explore unhealthy diet and lifestyle factors associated with female androgenetic alopecia (FAGA) in a community-based study.

METHODS

A total of 3,008 participants were recruited from the Jidong community (Tangshan, Hebei, China). FAGA was assessed by the Savin scale. Data collection was conducted through structured questionnaires. Univariate and multivariate logistic regression analyses were employed to identify potential factors. Multivariable models were built by selecting covariates with P < 0.05 in univariable analyses and removing collinear variables identified by a variance inflation factor > 5. The predictive performance was evaluated using the receiver operating characteristic curve.

RESULTS

The prevalence of FAGA in this study was 6.85% (206/3008). Sleep snoring (adjusted odds ratio [AOR] = 1.398, 95% confidence interval [CI] 1.032-1.894, P = 0.031), frequent consumption of bacon and preserved meat (AOR = 2.205, 95% CI 1.181-4.118, P = 0.013), frequently drinking unboiled water (AOR = 1.984, 95% CI 1.156-3.406, P = 0.013), age (AOR = 1.063, 95% CI 1.050-1.076, P < 0.001) and suboptimal health status score (AOR = 1.033, 95% CI 1.020-1.047, P < 0.001) were identified as independent factors associated with FAGA.

CONCLUSIONS

In conclusion, our data suggest that females who snore during sleep, frequently consume bacon and preserved meats, and regularly drink unboiled water are more susceptible to androgenetic alopecia. Additionally, our analysis revealed that age and suboptimal health status score are significantly correlated with FAGA.

Caffeine as an Active Ingredient in Cosmetic Preparations Against Hair Loss: A Systematic Review of Available Clinical Evidence

Background/Objectives: Hair loss (alopecia or effluvium) can significantly affect the self-esteem and psychosocial well-being of patients, resulting in a reduced quality of life. It may herald a systemic disease, nutritional deficiency, or side effects of pharmacotherapy. Current therapeutic options for hair loss are not always satisfactory and may be associated with considerable side effects; therefore, new solutions are still sought. Caffeine seems to be an effective agent against hair loss thanks to its stimulating effects on cell growth and good penetration into the hair follicle. The aim of this study was to systematically review published clinical trials of topical caffeine preparations against hair loss. Methods: We searched PubMed, Scopus, and Web of Science for clinical trials investigating the efficacy of topical caffeine products in hair loss, published until 29 November 2024. The quality of evidence was assessed using the GRADE classification. Results: The query returned 1121 articles, of which 9 ultimately met the inclusion criteria. In total, 684 people with androgenetic alopecia, excessive hair loss, or hair thinning were included in these trials. In all studies, conclusions were in favor of topical caffeine treatment; however, the level of scientific evidence was medium in 3 studies, low in 1, and very low in the remaining 5. Their major flaws included the lack of randomization and placebo and control groups, as well as the lack of information on the caffeine concentration in the topical products. Conclusions: Results from studies published to date suggest that topical caffeine preparations are safe and effective against hair loss. Nevertheless, better-designed clinical trials of well-defined caffeine products are required for an ultimate statement. Commercial hair products with caffeine offered on the market nowadays may be worth a try, but due to incomplete scientific data and product information, satisfactory outcomes are not guaranteed.

Dahuang-Gancao decoction ameliorates testosterone-induced androgenetic alopecia in mice

ETHNOPHARMACOLOGICAL RELEVANCE

Dahuang-Gancao decoction (DGD) is a traditional Chinese medicinal formula that is recorded in the Synopsis of the Golden Chamber, and is widely used to treat damp-heat in the body. Since the pathological factors of androgenetic alopecia (AGA) also reflect damp-heat blockage, DGD has great potential for the treatment of AGA and has been used effectively in clinical practice.

AIM OF THE STUDY

The aim of the study was to investigate whether external application of DGD could promote the activation and proliferation of hair follicle stem cells (HFSCs) and improve AGA through the Wnt/β-catenin pathway.

MATERIALS AND METHODS

The main chemical components of DGD-contained serum were identified by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and database search. Cell Counting Kit-8 (CCK8) was used to investigate the appropriate concentration. Hair regeneration was assessed by hair growth score and histopathological staining. The proliferation of HFSCs and the activation of Wnt/β-catenin pathway were detected by Western blot, immunofluorescence staining, real-time reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and enzyme-linked immunosorbent assay (ELISA). The AGA mouse model was induced by external application of testosterone (T). Immunofluorescence staining was performed to localize HFSCs by CK15, followed by staining with Ki67, β-catenin, and Cyclin D1, respectively.

RESULTS

The results illustrated that the 10% DGD group and the 10% DGD + HLY78 group could significantly promote the expression of Wnt10b and β-catenin and the proliferation of HFSCs in vitro, while the 10% DGD + IWR-1 group could reverse the promotion effect of DGD. Animal experiments showed that compared with the model group (T group), DGD promoted hair follicles to enter the anagen phase, as evidenced by an increase in hair growth score, an increase in the number of hair follicles in hematoxylin and eosin (HE) staining, and a significant increase in the ratio of the number of anagen follicles to the total number of hair follicles (AF/AF + TF). In addition, DGD upregulated the expression of Wnt/β-catenin signaling pathway proteins in the skin tissues of AGA mice. It also promoted the proliferation of HFSCs and the expression of β-catenin and Cyclin D1 cytokines in the region of HFSCs.

CONCLUSION

Both oral and external application of DGD can promote the proliferation of HFSCs by activating the Wnt/β-catenin signalling pathway. External application of DGD can promote the hair follicles to enter the anagen phase, which can ameliorate the symptoms of alopecia in AGA mice. Therefore, compared to oral DGD, external application of DGD is an effective and safer way of administration for the treatment of AGA.

Autolougous platelet concentrates in esthetic medicine

This narrative review summarizes current knowledge on the use of autologous platelet concentrates (APCs) in esthetic medicine, with the goal of providing clinicians with reliable information for clinical practice. APCs contain platelets that release various growth factors with potential applications in facial and dermatologic treatments. This review examines several facial esthetic applications of APCs, including acne scarring, skin rejuvenation, melasma, vitiligo, stretchmarks, peri-orbital rejuvenation, peri-oral rejuvenation, hair regeneration and the volumizing effects of APC gels. A systematic review of literature databases (PubMed/MEDLINE) was conducted up to October 2023 to identify randomized controlled trials (RCTs) in the English language on APCs for facial rejuvenation and dermatology. A total of 96 articles were selected including those on platelet rich plasma (PRP), plasma-rich in growth factors (PRGF), and platelet-rich fibrin (PRF). Clinical recommendations gained from the reviews are provided. In summary, the use of APCs in facial esthetics is a promising yet relatively recent treatment approach. Overall, the majority of studies have focused on the use of PRP with positive outcomes. Only few studies have compared PRP versus PRF with all demonstrating superior outcomes using PRF. The existing studies have limitations including small sample sizes and lack of standardized assessment criteria. Future research should utilize well-designed RCTs, incorporating appropriate controls, such as split-face comparisons, and standardized protocols for APC usage, including optimal number of sessions, interval between sessions, and objective improvement scores. Nevertheless, the most recent formulations of platelet concentrates offer clinicians an ability to improve various clinical parameters and esthetic concerns.

Exosome-derived long non-coding RNA AC010789.1 modified by FTO and hnRNPA2B1 accelerates growth of hair follicle stem cells against androgen alopecia by activating S100A8/Wnt/β-catenin signalling

BACKGROUND

The increased incidence of androgenic alopecia (AGA) causes adverse physiological and psychological effects on people of all genders. The hair follicle stem cells (HFSCs) have displayed clinical improvements on AGA. However, the molecular mechanism of HFSCs against AGA remains elusive.

METHODS

The expression and prognosis of lncRNA AC010789.1 in AGA hair follicle tissues were assessed by qRT-PCR analysis. CCK-8, EdU and Transwell analysis were utilized to assess cell growth. The specific binding between AC010789.1 and FTO mediated m6A modification or the effect of AC010789.1 on hnRNPA2B1, S100A8 and Wnt/β-catenin signaling expression was confirmed by bioinformatic analysis, RIP, RNA pull-down and Western blot assay. The effects of Exosome-loaded AC010789.1 prompted HFSCs proliferation and hair follicle regeneration were confirmed in hairless mice.

RESULTS

We herein found that the mRNA levels of lncRNA AC010789.1 were decreased in AGA tissue samples but increased in HFSCs of surrounding normal tissue samples. Overexpression (OE) of AC010789.1 promoted HFSC proliferation, DNA synthesis and migration as well as K6HF and Lgr5 upregulation, whereas knockdown of AC010789.1 showed the opposite effects. The total or AC010789.1 m6A levels were reduced and FTO demethylase was upregulated in AGA tissue samples, but these indicated the reverse results in HFSCs of surrounding normal tissue samples. FTO OE decreased AC010789.1 m6A levels and its mRNA levels in HFSCs and abolished AC010789.1-induced HFSCs proliferation. In addition, AC010789.1 was identified to bind to m6A reader hnRNPA2B1, which was downregulated in AGA but upregulated in HFSCs of surrounding normal tissue samples. hnRNPA2B1 OE attenuated AC010789.1 knockdown-induced inhibition of HFSCs proliferation. Moreover, AC010789.1 could bind to and enhance downstream S100A8 protein expression, which mediated Wnt/β-catenin signaling to accelerate HFSCs proliferation. Exosome-loaded AC010789.1 prompted HFSCs proliferation and hair follicle regeneration in mice.

CONCLUSIONS

Our findings demonstrated that exosome-derived lncRNA AC010789.1 modified by FTO and hnRNPA2B1 facilitated the proliferation of human HFSCs against AGA by activating S100A8/Wnt/β-catenin signaling.

KEY POINTS

Long non-coding RNA (lncRNA) AC010789.1 was downregulated in hair follicle tissues from androgenic alopecia (AGA) and upregulated in hair follicle stem cells (HFSCs). LncRNA AC010789.1 promoted the proliferation and migration of HFSCs. FTO/hnRNPA2B1-mediated m6A modification of lncRNA AC010789.1 promoted HFSCs growth by activating S100A8/Wnt/β-catenin signalling. Exosome-derived AC010789.1 accelerated HFSCs proliferation.

Causal relationship between gut microbiota and androgenetic alopecia: A Mendelian randomization study

Recent studies have found a strong correlation between gut microbiota and the risk of skin diseases and proposed a "gut-skin axis." Androgenetic alopecia (AGA) is the most common type of alopecia, and androgen plays an important role in its pathogenesis. It has been found that the gut microbiome is closely related to androgens; however, whether this relationship is causal or merely coincidental remains uncertain. To address this issue, Mendelian randomization (MR) analysis was performed to explore the association between gut microbiota and AGA. Genome-wide association studies (GWAS) have compiled summary statistics of the gut microbiota, including 211 taxa (131 genera, 35 families, 20 orders, 16 classes, and 9 phyla), with data from MiBioGen's comprehensive study. We collected genetic associations with AGA from the IEU OpenGWAS project. We performed MR Analyses to assess the causal relationship between the genetically predicted gut microbiota and AGA. In order to verify the reliability of the findings, we systematically performed sensitivity analyses and heterogeneity tests and performed a heterogeneity test. MR Analysis provides important evidence for the causal relationship between genetically predicted gut microbiota and AGA. Lachnospiraceae UCG008 (OR = 0.939, 95%CI 0.175-0.775, P < .01), Oxalobacte (OR = 0.932, 95%CI 0.896-0.969, P < .01) would reduce the risk of AGA. Eubacterium rectale group (OR = 1.102, 95%CI 1.025-1.186, P < .01), Roseburia (OR = 1.183, 95%CI 1.048-1.336, P < .01) would increase the risk of AGA. Further sensitivity and heterogeneity analyses confirmed the robustness of these results. The results of this study indicate that there is a potential genetic susceptibility between gut microbiota and AGA, and screen out protective and risk factors. These results provide a theoretical basis for the prevention and treatment of AGA by regulating gut microbiota.

Discovery of a Novel Non-invasive AR PROTAC Degrader for the Topical Treatment of Androgenetic Alopecia

Elevated expression levels and enhanced activity of androgen receptor (AR) proteins are key factors in the development of androgenetic alopecia (AGA). AR proteolysis-targeting chimera (PROTAC) degraders have shown therapeutic potential, but their poor skin permeability requires invasive delivery methods. In this study, we conducted a structure feature analysis to investigate the effects of different linkers and E3 ligands of AR PROTACs on skin retention properties and degradation potency. Among these, compound C6 was discovered with excellent skin retention properties and nanomolar level AR degradation. By degrading AR, C6 regulated the expression levels of downstream paracrine factors associated with AGA. Additionally, after non-invasive topical application, C6 demonstrated excellent skin accumulation and achieved hair regeneration in an AGA mouse model. Overall, the development of non-invasive C6 offers a promising new strategy for AGA treatment and highlights the potential for using PROTACs in treating other skin diseases.

Effects of photobiomodulation on human hair dermal papilla cells with various light modes and light parameters

Androgenetic alopecia (AGA) is a prevalent hair loss disorder and influenced by genetic, hormonal, and environmental factors. Minoxidil and finasteride have been widely used for treating AGA. However, the side effects associated with these drugs often lead to poor patient compliance. In contrast, photobiomodulation (PBM), due to its safety and non-invasiveness, holds promising prospects for use. Although the promoting effects of PBM on AGA have been reported, the mechanisms by which PBM affects dermal papilla cells (DPCs) remain largely unknown. Hence, this study explored the impacts of both continuous wave (CW) and pulsed wave (PW) PBM on DPCs, and revealed the underlying actions of light parameters in PBM. Orthogonal experiments were conducted to evaluate the effects of CW PBM on DPCs at varying irradiances and doses, indicating that irradiance was the crucial parameter, as well as cell viability and proliferation were maximized at 8 mW/cm2 and 8 J/cm2. For PW PBM, response surface methodology was employed to determine the influences of duty cycles, frequencies, and doses. The findings highlighted frequency as a primary factor, with the optimum cell viability observed at peak irradiance 10 mW/cm2, duty cycle 80 %, 500 Hz, and 8.8 J/cm2. Notably, PBM could enhance cell viability, proliferation, and migration in DPCs by activating the Wnt/β-Catenin signaling and suppressing Transforming Growth Factor signaling, particularly when applied in pulsed mode. Overall, this study determined the key light parameters that influence PBM effectiveness, further identified the optimal light conditions, and preliminary revealed into the mechanisms of PBM in DPCs, highlighting that PW PBM may be a competitive therapeutic option for alleviating AGA in the future.

A finasteride patch for the treatment of androgenetic alopecia: A study of promoting permeability strategy using synthetic novel O-acylmenthols combined with ion-pair

Currently, finasteride (FIN) is approved to treat androgenetic alopecia only orally, and the application of FIN in transdermal drug delivery system (TDDS) has introduced a new approach for treating the disease. This study was aimed to develop a FIN transdermal patch for the treatment of androgenetic alopecia（AGA） by combing ion-pair and O-acylmenthols (AM) as chemical permeation enhancers (CPEs). The formulation of patch was optimized though single-factor investigation and Box-Behnken design. The pharmacokinetics and androgenetic alopecia pharmacodynamics of the patch were evaluated. Additionally, the permeability enhancement mechanisms of ion-pair and AMs were explored at both the patch and skin levels. The effects of ion-pair and AMs on the patch were characterized by rheology study, FTIR, and molecular docking, and the effects on the skin were assessed through ATR-FTIR, Raman study, DSC, CLSM and molecular dynamics. The finalized formulation of FIN patches was consisted of 5 % (w/w) synthetic FIN-CA (Citric Acid), 6 % MT-C6 as CPEs, 25-AAOH as a pressure-sensitive adhesive (PSA), with a patch thickness of 80 ± 5 μm. The final Q24 h is 78.22 ± 5.18 μg/cm2. Based on the high FIN permeability, the pharmacokinetic analysis revealed that the FIN patch group exhibited a slower absorption rate (tmax = 7.3 ± 2.7 h), lower peak plasma concentration and slower metabolic rate (t1/2 = 6.2 ± 0.8 h, MRT0-t = 26.0 ± 7.8 h) compared to the oral group. Moreover, the FIN patch also demonstrated the same effect as the oral group in promoting hair growth in AGA mice. The results indicated that both FIN-CA and AMs could enhance the fluidity of the PSA and weaken the interaction between FIN-CA and PSA, thereby promoting the release of the FIN from the patch. The interaction sites on the skin for ion-pair and the four AMs were found in the stratum corneum (SC) of the skin, disrupting the tight arrangement of stratum corneum lipids. This study serves as a reference for the multi-pathway administration of FIN and the combination of ion-pair with AMs to enhance drug permeation.