Efficacy and Safety of Platelet-Rich Plasma Versus Topical Minoxidil in Androgenetic Alopecia: A Systematic Review.

Choosing between single-agent and combined therapies for androgenetic alopecia (AGA) remains a frequent clinical challenge, particularly when comparing topical options against autologous treatments. This study compares how 5% topical minoxidil and autologous platelet-rich plasma (PRP) perform against each other alone and in combination, focusing on efficacy, side effects, and patient satisfaction. The search covered the Cochrane Central Register of Controlled Trials (CENTRAL), Medical Literature Analysis and Retrieval System Online (MEDLINE), PubMed, Scopus, Latin American and Caribbean Health Sciences Literature (LILACS), and Scientific Electronic Library Online (SciELO) up to May 2026. We targeted prospective randomized controlled trials (RCTs) comparing or combining minoxidil 5% with PRP in adult cohorts (≥18 years). Quality assessment relied on Cochrane Risk of Bias 2 (RoB 2). Four trials enrolling 226 patients qualified for analysis. Monotherapies displayed distinct clinical patterns. Topical 5% minoxidil generated steady hair shaft thickness over extended follow-up. In contrast, monthly PRP injections induced rapid initial hair pull test conversion by week 12. Combined administration showed more favorable clinical outcomes compared to individual monotherapy arms across evaluated endpoints, with individual trials reporting up to 66.7% hair diameter gains, higher trichoscopic hair counts, and patient satisfaction rates reaching up to 90%. Complications remained local and minor, presenting as mild scalp itching with minoxidil and transient post-injection soreness with PRP. Marked variation in PRP preparation methods, spin protocols, and injected volumes prevented quantitative pooling. Studies evaluated predominantly male cohorts during short six-month tracking windows. Single-agent regimens provide partial responses without clear overall dominance. Adding monthly PRP injections to daily 5% minoxidil demonstrates promising comparative efficacy for vertex density restoration, though further standardized trials are warranted.