Objectives: Objectives -To explore cetirizine’s potential as a PGD2 pathway inhibitor and its role in reducing hair follicle miniaturization in AGA.
Introduction: Cetirizine has demonstrated inhibitory effects on prostaglandin D2 synthesis, a molecule implicated in the pathogenesis of hair follicle miniaturization in AGA. PGD2 acts as a potent inhibitor of hair growth by inducing catagen, the regression phase of the hair cycle, and reducing the anagen phase duration. Cetirizine's ability to block PGD2 receptor pathways offers a novel mechanism for combating AGA progression.
Materials / method: Men between 18 to 60 years of age with AGA, Norwood - Hamilton grade III vertex to V were enrolled. Men on minoxidil, finasteride, or other anti-androgenic medications within the past 6 months were excluded. The patients were given 1ml of 1% topical cetirizine in 30% propylene glycol and 30% butylene glycol daily for 16 weeks. Patients were also given non-medicated shampoo. No other topical or systemic therapy was given. Two efficacy parameters assessed were: hair count and 7-point evaluation Global photography images were captured on an Indigenous stereotactic device.
Results: Ten men were recruited. An increase in the hair count in 9/9 subjects post 16 weeks of therapy( one drop out). The mean hair count at week 0 was 139.56 (SE of the mean of 13.92) while the mean hair count at 16 weeks was 163.44 (SE of mean of 15.52)(P< 0.05). Global photography evaluation showed one patient had +2 change, two had +1 change, and six had no change. None of the patents reported any adverse effects.
Conclusion: Cetirizine's ability to block PGD2 receptor pathways offers a novel mechanism for combating AGA progression. All nine patients showed increased hair count on trichoscopy compared to baseline, however standardized photographs revealed improvement in only three. This discrepancy arises because hair grows at approximately one cm per month, so after four months, approximately four cm length of hair may not visibly enhance density in photographs. While current evidence supports its efficacy and safety, larger, randomized controlled trials are necessary
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