TOPLINE

Topical finasteride 0.25% monotherapy was well tolerated and significantly improved hair density, thickness, and terminal-to-vellus ratio in men with androgenetic alopecia (AGA) over a period of 52 weeks.

METHODOLOGY

• Researchers conducted a retrospective observational study of 123 adult men with AGA (Norwood-Hamilton scale grades 2-5; mean age, 32.4 years) treated with topical finasteride 0.25% monotherapy between April 2022 and November 2025.
• Patients applied either a hydroxypropyl chitosan-based solution using a commercial spray (n = 78; 2.275 mg/mL, with one to four sprays daily depending on the affected area size) or a compounded hydroalcoholic lotion containing finasteride 0.25% w/w (n = 45; 1 mL once daily using a graduated dropper).
• Participants were evaluated at baseline and after 52 weeks using standardised clinical photography and videodermoscopy (VIDIX system), with paired intrapatient comparisons of identical scalp target areas.
• Main outcomes included the total hair number (THN), hair shaft thickness (HST), and terminal-to-vellus hair ratio, assessed via trichoscopic evaluation at the vertex and/or frontotemporal regions; other outcomes were Physician Global Assessment (PGA), patient-reported satisfaction, and safety.

TAKEAWAY

• The mean THN increased from 145.3 hairs/cm² at baseline to 174.7 hairs/cm² at 52 weeks in the frontotemporal region (mean difference, +29.4 hairs/cm²; P < .001) and from 151.2 to 173.0 hairs/cm² in the vertex region (mean difference, +21.8 hairs/cm²; P < .001).
• The mean HST improved from 46.5 μm at baseline to 57.1 μm at 52 weeks (P < .001), and the mean terminal-to-vellus hair ratio increased from 2.6 to 4.3 at the vertex (P < .001), indicating a reversal of follicular miniaturisation.
• The PGA indicated overall improvement in 85% of patients (≥ 1-point improvement on the PGA scale), and patient-reported outcomes reflected perceived stabilisation or improvement of hair loss in 91% of the study cohort.
• No significant difference in efficacy endpoints was seen between patients using the commercial spray and those using the compounded solution.
• Topical finasteride had a favourable safety profile, with no serious adverse events. Local intolerance occurred in 7.3% of patients and consisted mainly of mild pruritus or transient erythema at the application site, which resolved without treatment discontinuation. 

IN PRACTICE

"Our 52-week data confirm sustained improvements in hair density and thickness, particularly in the frontotemporal region, with a lack of systemic sexual or mood-related adverse events. This supports its role as a primary therapeutic option for patients seeking to avoid oral 5-alpha-reductase therapy," the authors of the study concluded.

SOURCE

The study was led by Giuseppe Gallo, Dermatology Section, Department of Medical Sciences, University of Turin, Turin, Italy. It was published online on August 03, 2026, in Clinical and Experimental Dermatology.

LIMITATIONS

The study was retrospective, and the lack of a placebo arm or an active oral comparator prevented direct head-to-head superiority claims. Retrospective chart reviews relied on patient self-reporting, which may have introduced recall bias. Additionally, the variable application volume introduced clinical heterogeneity.

DISCLOSURES

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.