Combination treatment with minoxidil and retinoids

Experience has shown that some retinoids can affect the rate of hair growth, lengthening the anagen phase and shortening the telogen phase. These drugs independently stimulate hair growth and also increase the clinical effectiveness of minoxidil. With combined external use of tretinoin (0.025% and 0.05%) and minoxidil (1% and 2%), the trichogenic effect of the latter is enhanced, but at the same time, the excretion of minoxidil by the kidneys increases threefold. Special studies have shown that despite the increase in the concentration of the drug in the urine, its level in plasma did not increase, and no general hypotensive effect was observed. At the same time, it was noted that combined external therapy with retinoids and minoxidil caused a significant decrease in sebum secretion.

Interesting data were obtained when comparing various regimens of external therapy for patients with common alopecia. Five equal groups of patients, 25 people each, used one of the treatment regimens: tretinoin; minoxidil; minoxidil + tretinoin; triamcinolone acetate; tretinoin + triamcinolone acetate.

Tretinoin has been shown to significantly enhance the trichogenic effects of minoxidil and triamcinolone. The combination of tretinoin and triamcinolone was found to be most effective. No studies have documented the absorption of retinoids or their systemic effects.

Later, the local action of other retinoids was tested, in particular 13-cis-retinoic acid (isotretinoin). Densitometry showed a reliable decrease in sebum secretion (on average: 49%) in the areas of isotretinoin application. Dihydrotestosterone production in the scalp also decreased significantly (by 39.4% compared with baseline data). Hair counts after 9 months of therapy showed better results in the group of patients receiving combined treatment (isotretinoin and minoxidil) compared with patients using only isotretinoin.

Tretinoin (Ayrol, Lokacid, Retin-A) is available in a concentration of 0.1%-0.05% in the form of a solution, gel and cream; isotretinoin (Retinoic ointment) - a concentration of 0.01%-0.05% in the form of an ointment. The drugs are applied to the dry surface of the skin once a day.

Side effects. After applying the preparations, a short-term sensation of warmth and/or burning may occur. Local irritant action in the form of slight reddening of the skin may persist for up to 5-6 weeks of treatment. In case of more pronounced manifestations of simple dermatitis, the preparations should be applied less frequently. Since retinoids have a photosensitizing effect, insolation and artificial UV irradiation should be avoided during the treatment period.

Contraindications include hypersensitivity to retinoids and pregnancy (due to the possibility of teratogenic effects).

Finasteride

A 5a-reductase inhibitor successfully used in the treatment of prostate adenoma is able to prevent the development of common baldness. Promising results of its topical application (the drug "4-MA" - 4,N-diethyl-4-methyl-3-oxo-4-aza-5a-androstane-17b-carboxumide) were obtained in short-tailed macaques. Long-term (27 months) daily use of 4-MA, a topical 5a-reductase inhibitor, at a dose of 14 mg/ml in DMSO prevented hair loss in monkeys that had not reached sexual maturity; while in the control group, hair loss of varying severity was observed.

Thus, in addition to minoxidil solution and its analogues, 5a-reductase inhibitors can be used as an auxiliary agent for the treatment of common baldness. It should be emphasized that the results of their clinical trials in humans have not yet been published.

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