Melatonin in der topischen Behandlung der androgenetischen Alopezie

Zusammenfassung

Auf der Suche nach alternativen Substanzen zu Finasterid und Minoxidil für die Behandlung der androgenetischen Alopezie (AGA) wurde Melatonin, ein starkes Antioxidanz und Wachstumsmodulator, als Kandidat aus In-vitro- und In-vivo-Untersuchungen identifiziert. Insgesamt fünf klinische Studien zeigten bei guter Verträglichkeit positive Effekte einer topischen Melatonin-Behandlung auf die AGA bei Männern und Frauen: (1) Pharmakodynamisch zeigte sich unter einmal abendlicher topischer Anwendung kein signifikanter Einfluss auf die endogenen Melatonin-Plasmaspiegel. (2) In einer Anwendungsbeobachtung mit 30 Männern und Frauen mit Prüfarzt- und Probandenfragebögen zeigte sich nach 30 und 90 Tagen ein signifikanter Rückgang des Schweregrades der Alopezie (p < 0,001). (3) Mittels digitaler, Software-gestützter Auflichtmikroskopie (TrichoScan) wurde bei 35 Männern mit AGA bei 54,8 bzw. 58,1 % der Patienten nach 3 und 6 Monaten eine signifikante Zunahme der Haardichte um 29 % bzw. 41 % gemessen (M0: 123/cm^²; M3: 159/cm^²; M6: 173/cm^²) (p < 0,001). (4) Bei 60 Männern und Frauen mit Haarausfall wurde eine signifikante Reduktion des Haarverlustes bei den Frauen festgestellt, während bei den Männern der Haarausfall konstant blieb (p < 0,001). (5) In einer Multizenterstudie mit über 1800 Probanden in 200 Zentren über 3 Monate nahm der Anteil der Patienten mit 2- bis 3-fach positivem Pull-Test von 61,6 % auf 7,8 % ab und der Anteil der Patienten mit negativem Pull-Test von 12,2 % auf 61,5 % zu (p < 0,001). Zusätzlich wurde ein Rückgang der Seborrhö und der seborrhoischen Dermatitis der Kopfhaut beobachtet. Da die Sicherheit und Verträglichkeit in allen Studien gut war, kann die topische Anwendung einer kosmetischen Melatonin-Lösung eine sinnvolle Behandlungsoption bzw. Ergänzung bei androgenetischer Alopezie darstellen.

Abstract

On the search for new substances against androgenetic alopecia, melatonin, a strong antioxidant and growth modulator was identified as a promising candidate from in vitro and in vivo studies. Five clinical studies showed positive effects of a topical melatonin solution in the treatment of AGA in men and women while showing good tolerability: (1) Pharmacodynamics under once daily topical application in the evening showed no significant influence on endogenous melatonin plasma levels. (2) A use test with 30 men and women showed by evaluation of investigators and patients questionnaires a significant reduction of severeness of alopecia after 30 and 90 days (p < 0.001). (3) Using a digital software-supported epiluminescence-technique (TrichoScan) in 35 men with AGA, after 3 and 6 months in 54.8 % to 58.1 % of the patients a significant increase of hair density of 29 % and 41 %, respectively was measured (M0: 123/cm^²; M3: 159/cm^²; M6: 173/cm^²) (p < 0.001). (4) In 60 men and women with hair loss, a significant reduction of hair loss was observed in women, while hair loss in men was kept on a constant level (p < 0.001). (5) In a large 3-months multi-center study with more than 1800 volunteers in 200 centers, the percentage of patients with 2- to 3-fold positive hair pull test decreased from 61.6 % to 7.8 %, while the percentage of patients with negative hair pull test increased from 12.2.% to 61.5 % (p < 0.001). Additionally, a decrease of seborrhea and seborrhoic dermatitis of the scalp skin was observed. Since safety and tolerability in all studies was good, the topical application of a cosmetic melatonin solution can be considered as a meaningful treatment option or complementary treatment of androgenetic alopecia.

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