NEW YORK — Two drugs may be better than one for treating androgenetic alopecia in men.
The drugs are oral finasteride (Propecia) and topical minoxidil (Rogaine), Kenneth J. Washenik, M.D., said at a dermatology conference sponsored by New York University.
“We're now at a point where, if a patient will do it, combination therapy gives the best shot at growing hair,” he said. “It's hard for patients to use minoxidil; they're not thrilled about rubbing a topical into their thinning hair. And the results are slow, taking several months. But patients will have nice responses if they use both drugs.”
The mechanism of action of the two drugs is completely different. Definitive evidence for the superior efficacy of a combination regimen came in a 2002 report from researchers in New Delhi. They randomized 100 men with Hamilton grades II-IV baldness to one of four treatments in an open-label, controlled study (J. Dermatol. 2002;29:489-98). Thirty patients received 1 mg finasteride daily. A second group with 36 patients had combination treatment with the same dosage of finasteride plus daily, topical treatment with a 2% minoxidil formulation. The third group with 24 patients used minoxidil alone, and the fourth group with 10 patients used finasteride along with topical treatment with a 2% ketoconazole shampoo, said Dr. Washenik, medical director of Bosely Medical, a hair-loss clinic in New York and other locations in the United States.
Responses were assessed after 1 year. The best response was in the group treated with finasteride plus minoxidil. The treating physicians rated patients' responses as excellent (5.6%) and moderate (66.7%). This was the only treatment group in which any patients had an excellent response.