Combined topical minoxidil and finasteride therapy in androgenetic alopecia – narrative review

Background Androgenetic alopecia is a chronic progressive disorder characterized by androgen-dependent miniaturization of hair follicles mediated by dihydrotestosterone. Pharmacological management is based primarily on follicular stimulation with topical Minoxidil and inhibition of 5-α-reductase using Finasteride. Because systemic finasteride may be associated with hormonal exposure, interest has shifted toward topical formulations and combined topical therapy. Aim The aim of this study was to evaluate recent clinical evidence regarding the efficacy and safety of concurrent topical minoxidil and topical finasteride therapy in patients with androgenetic alopecia. Material and Methods A narrative literature review was performed using the PubMed database. Publications from 1 January 2019 onward were considered. A broad search combining terms related to alopecia, minoxidil and finasteride identified 261 records. After restricting the results to human clinical comparative or interventional studies and excluding review papers, meta-analyses and case reports, 19 records remained. Application of topical-administration criteria yielded 14 candidate publications. Following manual full-text analysis and exclusion of studies not employing simultaneous topical minoxidil and topical finasteride therapy, 5 studies fulfilled the eligibility criteria and were included in the qualitative synthesis. Results The included studies demonstrated improved hair density and clinical scalp appearance with combination therapy compared with minoxidil monotherapy. Topical finasteride provided local anti-androgenic activity while systemic exposure remained minimal. Reported adverse effects were uncommon and limited mainly to mild local irritation. Conclusions Combined topical minoxidil and topical finasteride therapy appears to improve treatment effectiveness while maintaining a favorable safety profile. Larger and longer-term controlled studies are required to determine durability of treatment effects and optimal dosing regimens.