The Efficacy and Safety of Oral and Topical Spironolactone in Androgenetic Alopecia Treatment: A Systematic Review

Abstract

Introduction

Androgenetic alopecia (AGA) has negative impacts on both men and women in terms of appearance and mental stress. Spironolactone is a synthetic aldosterone receptor antagonist known to stimulate hair growth and has been widely used by dermatologists to treat AGA.

Objective

To conduct a systematic review evaluating the efficacy and safety of topical and oral spironolactone in AGA treatment.

Methods

We searched PubMed, Embase, the Cochrane Library, and the Web of Science until October 23rd, 2022, for human studies evaluating the efficacy of spironolactone for the treatment of AGA, regardless of doses and routes.

Results

We retrieved 784 papers and ultimately 7 articles matched our inclusion criteria and comprised 618 AGA patients (65 men, 553 women), 414 of them received spironolactone treatment. Oral spironolactone doses ranged from 25mg to 200mg daily, with the vast majority between 80mg and 110 mg. Dosage forms for topical spironolactone use include gels of 1% and solutions of 5% twice daily. Both oral and topical spironolactone have been shown efficacy for alopecia recovery, but topical use has significantly fewer side effects and is suitable for any gender. It showed better efficacy in combination with other therapies such as oral or topical minoxidil compared with monotherapy.

Conclusion

Spironolactone is an effective and safe treatment of androgenic alopecia which can enhance the efficacy when combined with other conventional treatments such as minoxidil. Topical spironolactone is safer than oral administration and is suitable for both male and female patients, and is expected to become a common drug for those who do not have a good response to minoxidil. Furthermore, more high-quality clinical randomized controlled studies should be performed.

Keywords:

• androgenetic alopecia
• spironolactone
• dosage
• combine therapy
• efficacy
• adverse effects

Abbreviations

AGA, androgenetic alopecia; MPB, male pattern baldness; FPHL, female pattern hair loss; DHT, dihydrotestosterone; FDA, Food and Drug Administration; RCT, randomized controlled trials; NOS, Newcastle-Ottawa Scale; OCEBM, Oxford Centre for Evidence-Based Medicine; T/V, terminal hair/vellus hair.

Data Sharing Statement

All data analyzed in this systematic review can be searched in publicly available databases including PubMed, Embase, the Cochrane Library, and the Web of Science.

Ethics Approval

This is a review article and ethics approval should have been obtained by the original author.

Acknowledgments

We are thankful to Nanjing Medical University Library for providing a literature search platform and all the reviewers who made contribution to this article.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (No. 81972954).