Mesotherapy with dutasteride for androgenetic alopecia: a concise review of the literature.

Androgenetic alopecia is the most common form of alopecia. Its therapeutic approach is broad both in terms of active agents and routes of administration. Antiandrogens have been shown to be highly effective in both men and women. Mesotherapy with dutasteride, despite being an off-label technique, can be an effective alternative in cases of fear or refusal of, or poor tolerance to systemic treatment with anti-androgens. We present a review of the current evidence published to date on mesotherapy with dutasteride. Androgenetic alopecia (AGA) is the most common form of alopecia. Dihydrotestosterone (DHT) plays a major role in its pathogenesis as it causes hair miniaturization and shortening of the anagen phase [1]. Mesotherapy consists of a local drug injection at an adequate skin depth to enhance the therapeutic effect while minimizing systemic effects [2]. Mesotherapy with dutasteride reduces DHT levels in the scalp through the inhibition of 5-α-reductase types I and II [3]. Three placebo-controlled studies were published between 2009 and 2013. Abdallah et al. and Sobhy et al. showed the effectiveness of dutasteride 0.005% in men with AGA based on independent observer assessment (IOA) [4, 5], while Moftah et al. proved the efficacy of dutasteride 0.05% in women with AGA [6]. Later in 2017, a pilot study by Saceda-Corralo et al. with dutasteride 0.01% showed improvement in IOA in all patients evaluated [7]. Regarding the combination with minoxidil, Merinode-Paz et al., in 2018, achieved good outcomes in men and women with AGA with dutasteride 0.05% + minoxidil 2% [8], and in 2022, Villarreal-Villarreal et al. published the superiority of dutasteride 0.01% + oral minoxidil versus oral minoxidil monotherapy in the vertex area, but not in the frontal area [9]. Finally, Saceda-Corralo et al. presented a multicentre retrospective study with dutasteride 0.01% mesotherapy administered every three months in which more than 80% of the patients (men and women) clinically improved with no severe adverse effects [10]. The best technique for administration seems to be 0.05-0.1-mL injections at a depth of 4 mm, using fine needles (30G) and small syringes (1 mL) [11]. In summary, mesotherapy with dutasteride should be considered a safe and effective alternative for AGA, especially for patients who refuse oral anti-androgens or who have relative contraindications for them. ■