The efficacy of topical minoxidil 2% versus topical botanically derived inhibitors of 5 alpha reductase in treatment of female pattern hair loss by trichoscopy

Background Female pattern hair loss (FPHL) is a distressing common problem. Minoxidil is the only FDA approved medical treatment for FPHL. However, the off-label botanically derived 5-alpha reductase inhibitors (5aRIs) are commonly used despite insufficient studies.Objective To determine the effectiveness of topical botanically 5aRIs in treating FPHL, by comparing its results with topical minoxidil 2%.Patients and methods This study included 40 females with FPHL. Group 1 received topical minoxidil 2% and group 2 received topical botanically 5aRIs. Patients were clinically assessed via Savin scale; to compare between weeks 0 and 36. Change in hair diameter and count in the target site were trichoscopically assessed at weeks 0, 16, and 36. Side effects of both drugs were recorded.Results Minoxidil was effective in all disease stages, while 5aRIs were effective in early disease onset and moderate cases. Both drugs produced a significant rise in hair count and diameter, however; minoxidil had the superiority regarding the mean increase of hair diameter. Side effects of minoxidil were more troublesome.Conclusion Minoxidil is recommended as a first line of therapy for patients with FPHL who want a treatment with affordable price and could tolerate its side effects. Furthermore, it is advised to shift to topical botanical 5aRIs as a second line therapy, in cases that were nontolerant to minoxidil due to its fewer side effects. Likewise, the use of trichoscopy for therapeutic follow up is strongly recommended.