1Department of Dermatology, Saveetha Medical College and Hospital (SMCH), Saveetha Institute of Medical and Technical Sciences (SIMATS), Thandalam, Chennai-602105, Tamil Nadu, India; medasaishivaram@gmail.com (S.S.R.M) and drvarunrajagopal@gmail.com (V.R.S)
2Department of Research, Saveetha College of Nursing (SCON), Saveetha Institute of Medical and Technical Sciences (SIMATS), Thandalam, Chennai-602105, Tamil Nadu, India; mythileeswari@gmail.com (M.L) and anbubot373@gmail.com (T.A)
3*Natural Biomedicine Laboratory, Department of Dermatology, Saveetha Medical College and Hospital (SMCH), Saveetha Institute of Medical and Technical Sciences (SIMATS), Thandalam, Chennai-602105, Tamil Nadu, India; saktthivel@gmail.com (S.M)
Background: Androgenetic alopecia (AGA) is the most prevalent form of non-scarring hair loss, affecting up to 80% of men before age 70 and 42% of women over their lifetimes. The prostaglandin pathway has emerged as a mechanistically compelling therapeutic target: prostaglandin D2 (PGD2) is markedly elevated in balding scalp and potently inhibits follicular cycling through the GPR44/CRTH2 receptor, while prostaglandin F2alpha (PGF2alpha) and PGE2 promote the anagen growth phase.
Objectives: To systematically review published clinical and translational evidence on topical prostaglandin analogues specifically latanoprost, bimatoprost, and the PGD2 pathway modulator cetirizine in the treatment of AGA, evaluating efficacy, safety, and the current limitations of the evidence base.
Methods: A systematic search of PubMed/MEDLINE, Embase, and the Cochrane Library was conducted from database inception through January 2026, following PRISMA 2020 guidelines. Of 312 records identified, 65 duplicates were removed, leaving 247 unique records for title/abstract screening; 201 were excluded, yielding 46 full-text articles assessed for eligibility. After applying predefined inclusion and exclusion criteria, 6 primary original clinical studies in human AGA participants were included in the final synthesis, supplemented by foundational translational studies.
Results: Six clinical studies met final inclusion criteria. The pivotal RCT by Blume-Peytavi et al. (2012, n=16 men) demonstrated that latanoprost 0.1% significantly increased terminal and vellus hair density at 24 weeks (p<0.001 vs. baseline; p=0.0004 vs. placebo). Four studies of topical cetirizine 1% (Rossi et al. 2018; Zaky et al. 2021; Hossein Mostafa et al. 2021; Bassiouny et al. 2023) consistently demonstrated improved hair density in both male and female AGA with favorable tolerability. The oral GPR44 antagonist setipiprant failed to show significant superiority over placebo in a Phase 2a multicenter RCT (DuBois et al. 2021, n=169, p=0.9239). No peer-reviewed scalp efficacy data exist for bimatoprost despite multiple registered trials.
Conclusion: Topical prostaglandin analogues represent a biologically coherent but preliminary therapeutic class for AGA. No prostaglandin analogue currently holds regulatory approval for this indication, and the evidence base remains limited to small-scale or pilot-level studies with short follow-up. Large, adequately powered, long-term RCTs are essential before these agents can enter routine clinical practice.
Keywords: Androgenetic Alopecia, Prostaglandin Analogues, Latanoprost, Cetirizine, Hair Growth Therapy.
How to cite this article: Meda SSR, Srinivasan VR, Lakshmikanthan M, Ayyadurai T, Muthu S. Topical Prostaglandin Analogues in Androgenetic Alopecia: A Systematic Review of Clinical Evidence. Int J Drug Deliv Technol. 2026;16(15s): 108-117. DOI: 10.25258/ijddt.16.15s.13
Source of support: Nil.
Conflict of interest: None