Journal of

---

Backgound and Aim: One important limitation of random pattern skin flap in plastic surgery is the necrosis of distant parts of the flap resulting from ischemia. This effect cause unwanted increase in the costs and hospitalization. Previously, large number of factors has been evaluated to decrease the flap necrosis. In present study we used two drugs. Main reason was their mechanism of action that seems to be similar to preconditioning pathways.
Methods: ّFifty-six male rats were divided into four groups. In two groups 5% minoxidil or 5% azelaic acid were applied topically to the flap area before flap elevation. In some rats of minoxidil treated group, a non selective ATP sensitive potassium channel (KATP) blocker, glibenclamide (0.3mg/kg) was injected i.p. to evaluate the role of this channel in action. In azelaic acid treated rats, some were selected for evaluation of the role of nitric oxide and therefore L-NAME (20 mg/kg), a non-selective iNOS inhibitor, was administered. Seven days after operation, the extent of flap necrosis was calculated.
Results: Topical minoxidil or azelaic acid significantly recused necrotic area of skin flap to 42% (P<0.05) and 34% (P<0.01), respectively. Combination of minoxidil and azelaic acid was the most effictive intervantion on reducing of necrotic area to 26%. Glibenclamide abolished protective effect of minoxidil (P<0.001) and L-NAME inhibited the effect of azelaic acid on skin flap survival (P<0.05). Both L-NAME and glibenclamide completely inhibited the effect of combination topical therapy.
Conclusion: Present study suggested the role of KATP channels on minoxidil pathway and NO on L-NAME pathway of preserving skin flap survival. It seems that there is an overlap between the two pathways however precise mechanism remained to be determined.

---

Background and Aim: Androgenetic alopecia (AGA) is the most common type of alopecia in men. Currently, minoxidil is the only topical drug which has been approved by FDA for the treatment of AGA. However, its efficacy is restricted because of its low skin penetration. Since vesicular systems such as liposomes and niosomes have higher efficacy and lower adverse effects, this study was conducted to compare the efficacy of topical niosomal minoxidil with conventional minoxidil in the treatment of AGA. Methods: This study was a randomized, controlled double-blind clinical trial. Ninety male patients with AGA according to Hamilton criteria were enrolled into this trial. The participants applied the interversion to which they were allocated twice a day, and were evaluated monthly for 6 months by a physician and patients self-assessments. Results: Eighty-eight patients completed the trial. Mean increased hair count in niosomal minoxidil group and conventional minoxidil group in the last visit were 28.18±11.00 and 14.22±5.23, respectively (P<0.001). Moreover, evaluation of treatment response according to the patients self-assessments were 8.72±5.03 and 3.33±2.67 in niosomal and conventional minoxidil, respectively, which revealed more satisfaction in niosomal group (P=0.001). With the exception of two cases in niosomal minoxidil group whom were withdraw due to scalp itching and erthema no other adverse effect was observed in either group. Conclusion: In the present study, application of topical niosomal minoxidil revealed an increase in the hair count in comparison with conventional minoxidil solution. Application of this new formulation for the treatment of AGA may be recommended.

---

Background and Aim: Androgenetic alopecia (AGA) is the most common form of alopecia in men, worldwide and topical minoxidil appears to be the most effective and safe treatment for AGA beside oral finasteride. Safety assessment of topical minoxidil formulation could be conducted using in vivo studies on human volunteers. Using skin biophysical parameters is a fast and noninvasive method for safety assessment of topical products.

Methods: A topical combination of Minoxidil 5% solution in combination with chamomile extract from Iran’s pharmaceutical market tested on the skin of the forearm of 15 healthy volunteers. Changes in transepidermal water loss (TEWL), stratum corneum hydration, pH, melanin and hemoglobin contents have been evaluated, using biometric assessments with MPA 580 Cutometer®.

Results: There was not any significant change in skin hydration (P=0.692), TEWL (P=0.191), stratum corneum pH (P=0.613), melanin (P=0.533), and hemoglobin (P=0.579) contents before and after topical minoxidil application.

Conclusion: No significant change detected in skin erythema and assessed parameters Application of minoxidil 5% + chamomile 7% topical solution on human volunteers has not shown any adverse effects and these formulations could be recommended to use.

---

Androgenetic alopecia (AGA) is the most common form of non-scarring hair loss in both men and women, characterized by progressive miniaturization of hair follicles in androgen-sensitive areas. This condition is usually genetically determined and influenced by androgenic hormones, particularly dihydrotestosterone (DHT). The present review aims to summarize the epidemiological, pathophysiological, clinical, and therapeutic aspects of AGA based on the most recent scientific evidence up to 2025. Current evidence indicates that AGA is not merely a cosmetic issue but also a significant factor affecting patients’ psychological and social well-being. Available treatments include FDA-approved medications such as finasteride and minoxidil, as well as emerging modalities such as platelet-rich plasma (PRP) injection, microneedling, and low-level laser therapy. However, limited efficacy, the need for long-term treatment, and the occurrence of adverse effects have prompted ongoing research into novel and combination therapeutic approaches.