Mesotherapy With Dutasteride for Androgenetic Alopecia: A Retrospective Study in Real Clinical Practice

July 2022 | Volume 21 | Issue 7 | 742 | Copyright © July 2022


Published online June 23, 2022

David Saceda-Corralo MD PhDa,b, Farah Moustafa MDc, Óscar M. Moreno-Arrones MD PhDa,b, Pedro Jaén-Olasolo MD PhDa,b, Sergio Vañó-Galván MD PhDa,b, Francisco M. Camacho MD PhDd

aServicio de Dermatología, Hospital Universitario Ramón y Cajal. Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
bGrupo de Dermatología Pedro Jaén, Madrid, Spain
cDepartment of Dermatology, Tufts Medical Center, Boston, MA
dDepartamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain

Abstract
Background: 5-alpha inhibitors are an effective treatment for androgenetic alopecia. Mesotherapy with dutasteride has been proposed as an effective method to improve hair loss and reducing systemic absorption.
Objective: The main objective was to describe the safety profile of mesotherapy with dutasteride in real clinical practice in a large cohort of patients with androgenetic alopecia. A secondary aim was to describe the effectiveness of this treatment.
Methods and Materials: A multicentric retrospective study was designed. Patients treated with at least 6 months of follow-up were included in the study. Side effects and response to the treatment were analyzed.
Results: A total of 541 patients were included. The commonest approach during the first year was to perform the treatment every 3 months. Response to the mesotherapy in monotherapy could be assessed in 86 patients (15.9%) after one year. Most of them presented clinical improvement, being a marked improvement in 33 patients (38.4%). Pain was the most frequent side effect of the treatment (246 patients, 45.5%). No serious or sexual adverse events were detected.
Conclusion: Mesotherapy with dutasteride was effective in male and female hair loss in real clinical practice. Side effects related to the treatment were mild and self-limited. This therapy may be an effective option for select patients wishing to avoid oral treatment.

J Drugs Dermatol. 2022;21(7):742-747. doi:10.36849/JDD.6610

INTRODUCTION

Androgenetic alopecia (AGA) is the most frequent cause of hair loss in men and women. According to epidemiological studies, 80% of Caucasian men and 40-50% of women will develop AGA over the course of their lifetime.1 AGA is characterized by a decrease in hair density in androgenetic areas of the scalp due to a progressive miniaturization of the hair follicle. The etiopathogenesis is multifactorial and complex.2

Androgens play an important role. Their influence is especially relevant in men, and still controversial in women.3,4 Hair follicles in persons with androgenetic alopecia (AGA) are genetically susceptible to androgens. The activity of 5-alpha-reductase enzyme converts free testosterone into 5-α-dihydrotestosterone (5-α-DHT). 5-α-DHT binds to the androgen receptor in the dermal papilla of the hair follicle and activates the genes responsible for the gradual hair loss. After several hair cycles, the duration of anagen phase shortens and matrix size decreases, resulting in clinically evident miniaturized hairs.4 Peripheral antiandrogens, like the inhibitors of 5-alpha-reductase, have been proven to be effective in stopping this mechanism and also to revert hair thinning. Oral finasteride, which inhibits type II enzyme, is an FDA approved drug to treat AGA. Oral dutasteride inhibits both type I and II enzymes, and its use in AGA is considered off-label. The systemic use of both drugs has been attributed to side effects including sexual impotence, ejaculation disorders, and decrease of libido. Although clinical trials have not demonstrated a clear correlation between the use of these drugs and those side effects,5 they represent a primary concern for patients considering treatment.

In order to limit systemic absorption of 5-alpha-reductase inhibitors, their use as mesotherapy preparations has increased over the last several years. Mesotherapy technique involves microinjection of substances into the dermis or subcutaneous tissue for the treatment of various dermatological conditions, such as alopecia, cellulite, and wrinkles.6,7 Dutasteride-containing preparations might be an option to treat AGA in