Androgenetic alopecia is the most common form of hair loss [1, 2]. Recently, physical transdermal delivery technologies, such as iontophoresis and microneedling, have been explored to enhance the effectiveness of topical therapies while minimizing systemic exposure [3,4,5].

Tricopat® is a novel medical device combining skin patting, iontophoresis, and electrostimulation with red LED light therapy [3,4,5]. Treatments that combine controlled microdermal incisions, radial pressure waves, and iontophoresis have shown potential in enhancing scalp drug penetration, stimulating microcirculation, and promoting follicular activity. These effects are further amplified by the application of red LED light at the end of each session, known for its regenerative and anti-inflammatory properties [3,4,5]. In comparison to these treatments, dutasteride, which is a dual 5α-reductase inhibitor with a prolonged half-life and higher potency than finasteride, has shown promise as a topical agent in the treatment of AGA [2]. Dutasteride is preferred over finasteride in the protocol described here due to its longer half-life (approximately 5 weeks), which aligns well with the treatment schedule. Our findings support the utility of SPi and iontophoresis with a dutasteride gel as an effective, well-tolerated option for AGA in both sexes. The combination of physical and pharmacologic modalities appears to enhance follicular penetration and stimulate regrowth, even in previously treatment-resistant cases. These results align with earlier data on combination therapy of SPi-facilitated delivery of growth factors and corticosteroids (Fig. 1a-h) [3, 4]. This study has some limitations inherent to its pilot nature. First, the small sample size (n = 20) limits the statistical power and generalizability of the findings. Furthermore, no formal power calculation was conducted due to the exploratory design of the study. Second, the study design was open-label and non-randomized, without a control or comparator arm (e.g., sham device, topical dutasteride alone, or placebo), making it impossible to isolate the effects of the individual components of the combined treatment or to rule out placebo response. Third, outcome assessment relied partly on subjective and non-validated tools, including a custom patient satisfaction questionnaire and a non-blinded clinical improvement scale. Additionally, the lack of standardization in trichoscopic imaging and measurement protocols may have introduced variability. Finally, the follow-up period was relatively short (8 weeks after the final session), which may be insufficient to fully capture the long-term effects of a drug with a prolonged half-life like dutasteride. Future randomized, controlled trials with larger cohorts, validated outcome measures, and extended follow-up are needed to confirm and expand upon these preliminary observations.

Baseline and post-treatment global and trichoscopic images of two patients with androgenetic alopecia. a–d A 52-year-old female, e–h a 24 year-old male. a, e Global photographs at baseline (T0); c, g global photographs at the final visit after 4 therapeutic sessions. b, f trichoscopic images at baseline corresponding to a and e, respectively; d, h trichoscopic images at the final visit corresponding to c and g, respectively