Laser Assisted Delivery of Minoxidil in Androgenetic Alopecia

The objective of this study is to evaluate the safety and efficacy of fractionated ablative 10,600nm CO2 laser assisted delivery of 2% minoxidil solution in the treatment of MPHL. In this cohort study, patients will randomly be assigned stand-alone laser treatment, laser assisted drug delivery of minoxidil 2% solution, and laser assisted drug delivery of minoxidil 2% solution plus at home 5% minoxidil treatment. The primary endpoints will be to assess the change from baseline in investigator and subject Hair Growth Assessments (HGA), Hair Growth Index (HGI) and the Hair Growth Satisfaction Scale (HGSS) over 8-12 weeks in each of the three groups. The secondary endpoints will be expert assessment of hair density from baseline and evaluation of safety and adverse events, and pharmacokinetic (PK) data.

Male pattern hair loss (MPHL) is a common, frustrating, and difficult to manage scalp disease with few treatment options available. Though the mechanism remains unclear, minoxidil is a well-established treatment for MPHL. With the advent of laser assisted drug delivery, the investigators seek to investigate the use of laser assisted minoxidil delivery to improve bioavailability, and subsequent hair growth for subjects MPHL. With an improved clinical outcome and increased treatment efficiency, patient quality of life would be enhanced and fewer at home topical treatments with minoxidil may be required. Additionally, this study will assist in understanding the effects of stand-alone laser therapy on hair growth and may also be used as a background or framework for a growing number of studies investigating this technology as a drug delivery system.

MPHL, also known as androgenetic alopecia, is a non-scarring alopecia resulting in gradual hair loss localized to the scalp. In men, this progressive hair loss disorder results in characteristic thinning of hair over the vertex and frontal regions.1 The Hamilton-Norwood scale categorizes this typical clinical progression.2 While the pathogenesis of MPHL is not entirely elucidated, it has been proposed to be an age and hormone dependent process with dihydrotestosterone playing a significant role.2,3 Genetic factors may also contribute to the disease.4

Topical minoxidil is an FDA approved treatment for MPHL. Minoxidil 2 and 5% solution are known to increase hair regrowth in men with androgenetic alopecia.7 While the mechanism remains unknown, it has been proposed minoxidil increases the duration of anagen and vascular supply to the follicular structure.8

Topical treatments for MPHL such as minoxidil have limited efficacy, as topical delivery of medication has low bioavailability.9 With the advent of fractionated ablative and non-ablative laser technologies, more efficient drug delivery to the level of the superficial epidermis and dermis is now possible.

The outermost layer of skin, the stratum corneum, impedes the diffusion of topical medications to follicular structures in the dermis and hypodermis. 9 Ablative fractionated laser devices create vertical channels, permitting topical medication to breach the skin's top layer, the stratum corneum, and reach deep skin layers where hair follicles reside.9

Both ablative and non-ablative fractionated laser treatments augment collagen deposition and cause growth factor mediated changes to skin ultrastructure.10 Non-ablative fractionated laser therapy in MPHL patients improves hair density with and without topical administration of growth factor.10 Our proposed study confers an additional mode of treatment beyond laser-only therapy by using an ablative fractionated laser to deliver minoxidil 2% solution percutaneously.

Herein, the investigators seek to further optimize patient treatment by investigating a combination of these treatment modalities for management of MPHL. The investigators hypothesize that fractionated ablative 10,600nm CO2 laser treatment and laser assisted drug delivery of minoxidil 2% solution will result in increased hair growth. With this improved clinical outcome and increased treatment efficiency, patient quality of life will be enhanced and fewer at home topical treatments may be required.

Eligibility Criteria:
Inclusion Criteria:

1. Males ages 21-65 years old with MPHL
2. Norwood III vertex-V. The vertex scalp must be involved
3. MPHL diagnosed by a board-certified dermatologist
4. Willing to abstain from use of over the counter products and prescription products other than those supplied in the study
5. Willing to abstain from the use of non-steroidal anti-inflammatory medications, aspirin, St. Johns Wart, and high doses of Vitamin E supplementation
6. Subjects must be capable of giving informed consent
7. Willing to adhere to protocol, including scalp examinations and photography

Exclusion Criteria:

1. Allergy or intolerance to minoxidil
2. Underlying disease that might be adversely affected by minoxidil.
3. Immunosuppressed patients (history of transplantation, cancer, chemotherapy, splenectomy, HIV)
4. Application of topical immunomodulatory or immunosuppressive agent in the preceding 6 weeks
5. Systemic administration of corticosteroid or other systemic treatment (e.g. prednisone) that has immunomodulatory or other immunosuppressive mechanism of action, in the preceding 8 weeks or planned usage at any time throughout the study
6. Clinical evidence of secondary skin infection (e.g. folliculitis)
7. Other inflammatory or infectious skin disease that might interfere with evaluations during the study
8. Investigational medications within the past 30 days
9. Severe allergies manifested by a history of anaphylaxis, or history or presence of multiple severe allergies
10. Oral retinoids within the past 6 months and topical retinoid usage within the past 4 weeks
11. Patients with history of or susceptible to keloid formation
12. Finasteride or dutasteride within the past 6 weeks
13. Spironolactone within the past 6 weeks
14. Active infection
15. Lesions in the treated area suspicious for malignancy
16. Known allergy to hair dye or hair dye components
17. Relevant history of hypotension
18. Hypertension that is untreated or uncontrolled
19. Radiation or chemotherapy to the site
20. Use of topical or oral ketoconazole in the past 6 weeks
21. Hair transplants or weaves
22. Other concomitant types of history of hair loss such as telogen effluvium
23. Medical problems including HIV, connective tissue disorder, PCOS, untreated thyroid disease
24. Psychiatric disease that that may increase risks within the trial
25. Current use of tanning beds or any active tanning
26. Use of antihypertensives or vasodilators following a first-time diagnosis of hypertension within the past 6 months
27. Planned upcoming surgeries
28. Tattoo on scalp
29. Use of oral minoxidil within the past 6 months
30. History of orthostatic hypotension
31. Adults lacking capacity to consent
32. Adults who do not speak English.
33. A medical history or clinical evidence of: acute myocardial infarction, angina, cardiac disease, cardiac tamponade, cerebrovascular disease, coronary artery disease, hypotension, orthostatic hypotension, pericardial effusion, peripheral edema, heart failure, pulmonary hypertension, renal disease, renal failure, renal impairment, pregnancy, breast-feeding, children, pheochromocytoma, skin abrasion, and geriatric.