Efficacy and safety of combined topical estradiol with minoxidil vs. topical minoxidil in female pattern hair loss: a trichoscopic randomized controlled trial.

BACKGROUND: Female pattern hair loss (FPHL) is common and has a negative impact on quality of life. FPHL is more challenging to treat than male pattern hair loss, with minoxidil being the gold standard treatment. Several studies have used 17α-estradiol solution for treating FPHL with variable results, either alone or combined with minoxidil. OBJECTIVES: To study the safety and efficacy of topical 17α-ethinylestradiol 0.01% combined with minoxidil 2% in comparison with minoxidil 2% in the treatment of FPHL. METHODS: Forty-three women with FPHL were recruited to this randomized controlled study and were asked to blindly apply twice daily six puffs of a spray-on solution containing either 17α-ethinylestradiol 0.01% combined with minoxidil 2% (EMX group) or minoxidil 2% alone (MX group). Treatment continued for 6 months. Clinical and trichoscopic assessments were performed at baseline and at the end of the treatment. RESULTS: At the end of the treatment period, both groups showed signs of improvement. Improvement parameters were better for the EMX group vs. the MX group, but this was not statistically significant. More patients in the EMX group experienced menstrual irregularities. Limitations include the limited number of patients and follow-up period. Also, the effects of estradiol were not studied on a cellular or molecular levels and systemic absorption of both medications was not determined. CONCLUSIONS: The use of a 0.01% 17α-ethinylestradiol with a 2% minoxidil solution in the treatment of FPHL does not seem to offer a statistically significant advantage compared with minoxidil alone and may carry a higher risk of associated menstrual irregularities.