Comparative Efficacy of Topical Finasteride (0.25%) in Combination with Minoxidil (5%) Against 5% Minoxidil or 0.25% Finasteride Alone in Male Androgenetic Alopecia: A Pilot, Randomized Open-Label Study

BACKGROUND: Androgenetic alopecia (AGA) is the most common cause of hair loss in males which remains a therapeutic challenge. OBJECTIVES: To compare the efficacy of topical 5% minoxidil and 0.25% finasteride combination (MNF) over 5% minoxidil (MNX) or 0.25% finasteride (FNS) alone by assessing hair count, physician assessment score (PAS), and patient satisfaction score (PSS). MATERIALS AND METHODS: Pilot randomized open-label study where 60 male patients with AGA ≥ III grade were randomized into three treatment groups and evaluated over 24 weeks. Improvement in hair count was assessed manually using dermoscopy. Global photographs were used to assess PAS. Side effects were evaluated using relevant laboratory investigations. RESULTS: At the 12(th) and 24(th) week, all three groups showed significant improvement in total hair density as compared to baseline (P < 0.001). None of the groups was superior to the other (P > 0.05) at the 12(th) week but at 24(th) week, MNF was comparatively superior (P < 0.02). At the 12(th) week and 24(th) week, all three groups showed significant improvement in terminal hair density as compared to baseline (P < 0.001). In the 12(th) week, MNF was comparatively superior (P = 0.028) and at the 24(th) week, MNF was comparatively superior (P < 0.02). PAS and PSS were significantly better with MNF and MNX compared to FNS (P < 0.004). Side effects such as scaling and itching were reported with MNF and MNX. CONCLUSION: Topical minoxidil 5% and finasteride 0.25% had an overall better efficacy compared to monotherapy without significant side effects.