Interventions for female pattern hair loss

Cochrane Database of Systematic Reviews minoxidil 2% group versus 28/320 in the placebo group (RR 1.24, 95% CI 0.82 to 1.87; low quality evidence).There was also no statistically significant di erence in adverse events between any of the individual concentrations against placebo.Four studies (1006 participants) evaluated minoxidil 2% versus 5%.In one study, 25/57 participants in the minoxidil 2% group experienced moderate to greatly increased hair regrowth versus 22/56 in the 5% group (RR 1.12, 95% CI 0.72 to 1.73).In another study, 209 participants experienced no di erence based on a visual analogue scale (P = 0.062; low quality evidence).The assessments of the investigators based on three studies (586 participants) were in agreement with these findings (moderate quality evidence).One study assessed QoL (209 participants) and reported limited data (low quality evidence).Four trials (1006 participants) did not show a di erence in number of adverse events between the two concentrations (RR 1.02, 95% CI 0.91 to 1.20; low quality evidence).Both concentrations did not show a di erence in increase in total hair count at end of study in three trials with 631 participants (mean di erence (MD) -2.12, 95% CI -5.47 to 1.23; low quality evidence).Three studies investigated finasteride 1 mg compared to placebo.In the finasteride group 30/67 participants experienced improvement compared to 33/70 in the placebo group (RR 0.95, 95% CI 0.66 to 1.37; low quality evidence).This was consistent with the investigators' assessments (RR 0.77, 95% CI 0.31 to 1.90; low quality evidence).QoL was not assessed.Only one study addressed adverse events (137 participants) (RR 1.03, 95% CI 0.45 to 2.34; low quality evidence).In two studies (219 participants) there was no clinically meaningful di erence in change of hair count, whilst one study (12 participants) favoured finasteride (low quality evidence).Two studies (141 participants) evaluated low-level laser comb therapy compared to a sham device.According to the participants, the lowlevel laser comb was not more e ective than the sham device (RR 1.54, 95% CI 0.96 to 2.49; and RR 1.18, 95% CI 0.74 to 1.89; moderate quality evidence).However, there was a di erence in favour of low-level laser comb for change from baseline in hair count (MD 17.40, 95% CI 9.74 to 25.06; and MD 17.60, 95% CI 11.97 to 23.23; low quality evidence).These studies did not assess QoL and did not report adverse events per treatment arm and only in a generic way (low quality evidence).Low-level laser therapy against sham comparisons in two separate studies also showed an increase in total hair count but with limited further data.Single studies addressed the other comparisons and provided limited evidence of either the e icacy or safety of these interventions, or were unlikely to be examined in future trials. Authors' conclusionsAlthough there was a predominance of included studies at unclear to high risk of bias, there was evidence to support the e icacy and safety of topical minoxidil in the treatment of FPHL (mainly moderate to low quality evidence).Furthermore, there was no di erence in e ect between the minoxidil 2% and 5% with the quality of evidence rated moderate to low for most outcomes.Finasteride was no more e ective than placebo (low quality evidence).There were inconsistent results in the studies that evaluated laser devices (moderate to low quality evidence), but there was an improvement in total hair count measured from baseline.Further randomised controlled trials of other widely-used treatments, such as spironolactone, finasteride (di erent dosages), dutasteride, cyproterone acetate, and laser-based therapy are needed.