INTRODUCTION
Androgenetic alopecia (AGA) is the most prevalent form of hair loss worldwide, affecting both men and women, with an estimated prevalence of up to 80% in males and approximately 40% in females, at some point of their lives.1 Its multifactorial etiology involves genetic predisposition and androgenic hormonal influences, primarily dihydrotestosterone (DHT), which acts on susceptible hair follicles. The central pathological mechanism is follicular miniaturization, with progressive hair shaft thinning and eventual hair loss.2
Recently, an expanding armamentarium of therapeutic options has become available, including systemic and topical pharmacological agents as well as procedural interventions such as mesotherapy, platelet-rich plasma (PRP), and hair transplantation. Among pharmacological treatments, 5-alpha-reductase inhibitors, such as finasteride/dutasteride, have demonstrated efficacy by reducing DHT levels. However, systemic administration is often limited by potential adverse effects, including decreased libido and gynecomastia, and contraindications, such as pregnancy/lactation.3 To mitigate these effects, alternative administration routes, such as localized scalp injections (mesotherapy), have gained popularity. Mesotherapy with dutasteride is increasingly performed, with treatment frequency ranging from once per week to once every 3 months, typically using concentrations from 0.005% to 0.05%.4 However, this technique is not devoid of complications. We report 3 cases of female patients with AGA who developed persistent alopecia following mesotherapy with dutasteride.
Clinical Cases
Case 1
The first case is a 44-year-old female with AGA and no relevant medical history, under oral finasteride 5 mg/day plus topical minoxidil 5%, and with a history of previous hair transplantation. The patient received a single session of mesotherapy with dutasteride (final concentration of 0.025%), mixed with an anesthetic solution (lidocaine, bupivacaine, adrenaline, and sodium bicarbonate). Treatment was administered using 4 mm, 30G needles, with 0.05–0.1 mL per site of injection and 1 cm spacing between injection sites, for a maximum total of 2 mL. The administration technique was similar in the cases described below.
Recently, an expanding armamentarium of therapeutic options has become available, including systemic and topical pharmacological agents as well as procedural interventions such as mesotherapy, platelet-rich plasma (PRP), and hair transplantation. Among pharmacological treatments, 5-alpha-reductase inhibitors, such as finasteride/dutasteride, have demonstrated efficacy by reducing DHT levels. However, systemic administration is often limited by potential adverse effects, including decreased libido and gynecomastia, and contraindications, such as pregnancy/lactation.3 To mitigate these effects, alternative administration routes, such as localized scalp injections (mesotherapy), have gained popularity. Mesotherapy with dutasteride is increasingly performed, with treatment frequency ranging from once per week to once every 3 months, typically using concentrations from 0.005% to 0.05%.4 However, this technique is not devoid of complications. We report 3 cases of female patients with AGA who developed persistent alopecia following mesotherapy with dutasteride.
Clinical Cases
Case 1
The first case is a 44-year-old female with AGA and no relevant medical history, under oral finasteride 5 mg/day plus topical minoxidil 5%, and with a history of previous hair transplantation. The patient received a single session of mesotherapy with dutasteride (final concentration of 0.025%), mixed with an anesthetic solution (lidocaine, bupivacaine, adrenaline, and sodium bicarbonate). Treatment was administered using 4 mm, 30G needles, with 0.05–0.1 mL per site of injection and 1 cm spacing between injection sites, for a maximum total of 2 mL. The administration technique was similar in the cases described below.
