Evaluation of the Efficacy and Safety of Topical Spironolactone versus Topical Minoxidil in the Treatment of Female Pattern Hair Loss: A Comparative, Clinical, and Trichoscopic Study.

Background: Female pattern hair loss (FPHL) is the most common hair loss disorder in women. Its origin is polygenic and multifactorial. Specific genetic factors predispose androgen receptors to be particularly sensitized so that they bind to circulating androgens, even with normal circulating levels.

Objectives: The aim of this work was to evaluate and compare the efficacy and safety of topical spironolactone versus topical minoxidil in the treatment of FPHL.

Methods: This prospective, simple randomized, comparative study was conducted on 80 female patients with FPHL. They were divided into two groups: Group (A): was subjected to topical spironolactone 1% gel application for 6 months, twice. Group (B): was subjected to topical minoxidil 5% gel application for 6 months, twice daily. The efficacy of treatment was assessed clinically by the Ludwig scale, Global Esthetic Improvement Scale, and trichoscopy.

Results: There was a statistically significant difference in improvement in both groups after treatment as regards: the Ludwig scale, Global Esthetic Improvement Scale, and Trichoscopy. In Group A: 10 patients had mild, 16 patients had moderate, two patients had excellent, and 12 had marked improvement. In Group B: 10 patients had mild, 14 patients had moderate, two patients had excellent, and 14 had marked improvement. Contact dermatitis, scalp irritation, and headache, which were more evident in Group B than in Group A.

Conclusions: Both topical spironolactone and topical minoxidil were cheap, safe, and effective lines for the treatment of FPHL with minimal and tolerable side effects.