A pilot study to evaluate effectiveness of botulinum toxin in treatment of androgenetic alopecia in males

Abstract

Introduction:Androgenetic alopecia is a common form of alopecia with multifactorial etiology. Finasteride and minoxidil are approved by the FDA for the treatment of androgenetic alopecia. Balding scalp is believed to have relative microvascular insufficiency. Blood vessels in the scalp travel through the intramuscular plane. Intramuscular injection of botulinum toxin relaxes muscles and thereby increases blood flow in balding scalp. We conducted a pilot study to evaluate the efficacy of botulinum toxin in androgenetic alopecia management.Material and Methods:The study was conducted in a tertiary care center. A total of 10 male patients with androgenetic alopecia meeting inclusion criteria of the study were included. In the scalp, 30 sites were injected with 5 U of botulinum toxin in each site. Preprocedure photograph taken and evaluation was done, which was repeated after 24 weeks. Efficacy was assessed by photography and self-assessment scoring was done by patients.Results:Of 10 patients, 8 had good to excellent response on photographic assessment. At the end of 24 weeks, 1 patient showed poor and 1 showed fair response to treatment. As per self-assessment, 7of 10 patients showed good to excellent response. Two patients had fair response and 1 patient showed poor response to treatment.Conclusion:Botulinum toxin was found to be safe and effective therapy for the management of androgenetic alopecia in this pilot study. Studies with larger sample size and randomized controlled trials are required to establish the role of botulinum toxin in the management of androgenetic alopecia.

Study of the Effectiveness and Safety of Botulinum Toxin Type- A for Treatment of Androgenetic Alopecia in men

“…The mean age of BTA groups was 38:47 ± 10.13 years, mean BMI was 23:12 ± 4:54 kg/m 2 and the mean duration was 8:85 ± 7:17 years. As well, the current study was further supported by the pilot study of Singh et al (7) aimed to assess the effectiveness of botulinum toxin in the treatment of androgenetic alopecia. In the trial, 30 locations on the scalp of 10 male patients with androgenetic alopecia received injections of 5 U of botulinum toxin apiece.…”

Intrauterine botulinum toxin A administration promotes endometrial regeneration mediated by IGFBP3-dependent OPN proteolytic cleavage in thin endometrium

“…The angiogenic effects of BoTA have been recently reported by demonstrating that BoTA treatment improved the long-term retention of autologous fat grafting via augmented vascularization [45] and promoted blood flow during perfusion of cutaneous and myocutaneous flaps [46,47]. In addition, BoTA injection enhanced neural regeneration in a murine model of tibial nerve neurotmesis [48], and intradermal injection of BoTA restored hair growth and regenerated hair follicle cells via suppression of neurogenic inflammation [49,50]. Furthermore, we previously suggested the extension of BoTA use indication to the uterus with the aim of enhancing fertility, demonstrating its effectiveness in elevating endometrial angiogenesis and receptivity [26].…”

Is there a rationale for the use of botulinum toxin in the treatment of Androgenetic Alopecia?

“…Additionally, in AGA, bald areas have some microvascular insufficiency, with lower oxygen (O 2 ) levels than non‐bald areas 5 . In part, this is due to the arterial supply of the apex being promoted by the branches of the trochlear and supraorbital arteries, which are the smallest branches of the internal carotid artery.…”

“…4 Additionally, in AGA, bald areas have some microvascular insufficiency, with lower oxygen (O 2 ) levels than non-bald areas. 5 In part, this is due to the arterial supply of the apex being promoted by the branches of the trochlear and supraorbital arteries, which are the smallest branches of the internal carotid artery. Moreover, the conversion of testosterone to dihydrotestosterone (DHT) occurs preferably in an environment that is poor in O 2, and therefore, the increase in blood supply would reduce local hypoxia and could be beneficial in the treatment of AGA.…”

“…Therefore, there would be a reduction in tissue DHT due to the effect known as "wash out," and consequently, less follicular miniaturization would occur, which is considered the main pathophysiological basis of this disease (Figure 1). [5][6][7] Interestingly, Chen et al recently showed that there is significantly greater scalp stiffness at the apex of men suffering from AGA when compared to other areas of the scalp. This stiffness could be related to fibrosis promoted by increased levels of TGF-β1 in the sites affected by the disease.…”