Topical Finasteride Shows Promise for Hair Loss in Postmenopausal Women, Suggests Study
Italy: A new study has found that topical finasteride 0.25% monotherapy was associated with significant improvements in hair density and thickness in postmenopausal women with female pattern hair loss (FPHL). The treatment also demonstrated favorable tolerability and patient compliance. These preliminary real-world observational findings suggest that topical finasteride may be a promising treatment option for this underserved population, although further studies are needed to confirm its efficacy and safety.
The study, published in the International Journal of Dermatology, was conducted by Bianca Maria Piraccini, Private Dermatology Practice, Bologna, Italy, and colleagues.
FPHL is the most common cause of hair thinning in women and is characterized by progressive miniaturization of hair follicles. Its prevalence increases after menopause. Although topical minoxidil is an established treatment, responses vary among patients. Oral finasteride is also used off-label in postmenopausal women, but concerns about systemic adverse effects have prompted interest in topical formulations that may reduce systemic exposure.
The study assessed changes in hair growth and treatment tolerability among 26 postmenopausal women with FPHL who received topical finasteride 0.25% alone for 52 weeks.
The researchers compared clinical photographs and trichoscopic images obtained before treatment and at Week 52. They measured hair density, hair thickness, and the ratio of terminal to vellus hairs in predefined areas of the frontal scalp or vertex. Patients and clinicians also rated treatment effectiveness, while participants reported tolerability and adherence.
The analysis revealed the following findings:
- Increased hair density: Mean hair density rose from 149.48 to 172.84 hairs/cm² after 52 weeks, representing an increase of 23.37 hairs/cm².
- Improved hair thickness: Average hair thickness increased from 40.42 to 51.04 μm, a gain of 10.62 μm.
- Improved hair quality indicators: The terminal-to-vellus hair ratio increased from 1.04 to 1.56, indicating a shift towards a higher proportion of terminal hairs.
- Favourable treatment experience: Patient and clinician assessments indicated good-to-excellent effectiveness. No adverse events were documented, and patients reported high tolerability and treatment compliance.
The researchers noted that the findings provide preliminary real-world evidence supporting further investigation of topical finasteride for postmenopausal women experiencing FPHL.
However, the study had several limitations. Its retrospective design, small sample size, and lack of a control group mean that the observed improvements cannot be attributed definitively to finasteride. Additionally, patient-reported effectiveness data were available for only 15 of the 26 participants, while including patients who completed the full 52-week treatment period may have favoured more positive outcomes.
The authors concluded that topical finasteride 0.25% was associated with improvements in hair density, thickness and hair-follicle composition, with favourable reported tolerability. They emphasised that larger prospective, randomised controlled trials are needed to confirm its efficacy and safety and compare its performance with established treatments such as topical minoxidil.
Reference:
Piraccini, B. M., Gupta, A. K., Cedirian, S., Rapparini, L., Quadrelli, F., H. Compton, S. A., Talukder, M., & Starace, M. Topical Finasteride 0.25% Solution for Female Pattern Hair Loss (FPHL) in Postmenopausal Women: A 52-Week Retrospective Observational Study. International Journal of Dermatology. https://doi.org/10.1111/ijd.70730
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