The addition of sulfotransferase enzymes to daily 5% minoxidil significantly improved hair regrowth compared with daily minoxidil alone in men with androgenetic alopecia, according to a study in the Journal of Cosmetic Dermatology.

The efficacy of minoxidil, the only topical therapy for hair regrowth approved by the US Food and Drug Administration, relies on certain enzymatic activity in the scalp. Sulfotransferase enzymes found in the outer root sheath of the hair follicles are responsible for converting minoxidil to minoxidil sulfate, the pro-drug’s active form. In particular, endogenous sulfotransferase 1A1 (SULT1A1) is the dominant isoform of the enzyme that plays a key role in the conversion of minoxidil.

Participants in this study were men with hair loss who were seen at a hospital’s outpatient dermatologist department in India. None of the patients had used minoxidil before study entry.


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The patients were randomly given either a 30-day supply of 5% topical minoxidil with adjuvant SULT1A1 (n=12) or 5% topical minoxidil with a sham (placebo) control (n=12).

Participants were told to apply the SULT1A1 or sham adjuvant solution 5 to 10 minutes before applying the minoxidil. The researchers evaluated hair growth at 30 days and 60 days using global photography. The photographs were reviewed by 3 independent and blinded experts.

At baseline, the mean Norwood scale score was 4.3 in the active intervention arm vs 4.4 in the placebo arm. Approximately 75% of patients in the SULT1A1 adjuvant and minoxidil arm demonstrated a positive increase in hair growth during the 60 days compared with only 33% of patients in the placebo adjuvant group (P =.023).

Limitations of this study included its small sample size as well as the limited duration of follow up.

The investigators suggest that efforts to improve “the rate of minoxidil response” with the enzyme solution “would also positively benefit compliance with the treatment regimen and have a synergistic benefit on efficacy.”

Reference

Dhurat R, Daruwalla S, Pai S, et al. SULT1A1 (Minoxidil Sulfotransferase) enzyme booster significantly improves response to topical minoxidil for hair regrowth. Published online June 16, 2021. J Cosmet Dermatol. doi:10.1111/jocd.14299