Paradoxical Nonscarring Alopecia Following Mesotherapy with Dutasteride: A Case Series.

Abstract

Background: Androgenetic alopecia (AGA) is a disease of polygenic etiology. Androgens play a vital role in the development of patterned hair loss. Dutasteride is an anti-androgen that acts by competitively inhibiting both type 1 and type 2 isoenzymes of 5α reductase. The intradermal deposition of dutasteride has the advantage of negligible systemic absorption. Although dutasteride mesotherapy has not been approved by the Food and Drug Administration, it has been used off-label in the treatment of AGA. Here, we report 4 case series of nonscarring alopecia that developed following a single session of mesotherapy injection.

Materials and methods: A total of 15 cases with patterned hair loss were enrolled (13 males and 2 females). The grade of patterned hair loss was between Norwood Hamilton grade 3-6, and in Ludwig pattern between 2 and 3. Once a month intradermal injection of dutasteride mesotherapy was administered in all cases. To standardize the drug administration and for uniform delivery of the drug, 1 cm² grids were created and 2 units at each point was administered at an angle of 60°, a total of 2 ml of 0.01% of dutasteride was administered in each session.

Results: Mean age of 31.53. The most common adverse effect noted was noncicatricial alopecia was noted in four cases, (3 males and 1 female), followed by pain, itching 1 case each, respectively. The grade of alopecia was AGA grade 5-6, 1 male with Ludwig grade 2 pattern of hair loss and a female with Ludwig grade 2. They developed patchy alopecia involving the mesotherapy site following a single session of dutasteride mesotherapy.

Conclusion: There is a need for stringent monitoring of manufacturing guidelines of mesotherapeutic cocktails by governing bodies. It should primarily address the optimal concertation of the active ingredients and preservative usage to avoid untoward side effects. The benzyl alcohol and polysiloxane in the cocktail could be the key players having cytotoxic effects, contributing to the development of alopecia. The knowledge of potential adverse effects caused by a drug should always be in the mind of the treating physician.