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Ten men with Hamilton–Norwood stage I–V, stable on minoxidil and excluding finasteride/dutasteride, received eight microneedling sessions over four months. The left scalp received 2 mL topical 4-AP 5% and the right scalp received intrapatient saline, with standardized trichoscopy and Trichoscan outcomes. No adverse events occurred, and no clinically meaningful improvements were observed in photography. Hair density changes were small and non-significant, without terminal/vellus ratio or shaft diameter shifts, suggesting a translational gap from wound-healing models.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/topical-4-aminopyridine-5-in-male-androgenetic-alopecia-a-split-scalp-exploratory-series/439029/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/topical-4-aminopyridine-5-in-male-androgenetic-alopecia-a-split-scalp-exploratory-series/439029.png","ImageObject",300,407,{"name":92,"@type":93},"Genevieve","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What treatment was tested in the split-scalp exploratory series?","Question",{"text":112,"@type":113},"Topical 4-aminopyridine (4-AP) 5% was applied to one scalp side, paired with saline as an intrapatient control on the other side, after microneedling sessions.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were patients assessed for efficacy over the study period?",{"text":117,"@type":113},"Efficacy was evaluated at baseline and after four months using global photography and standardized trichoscopy/Trichoscan at fixed scalp sites, plus hair pull testing.",{"name":119,"@type":110,"acceptedAnswer":120},"Did topical 4-AP 5% show measurable benefit for male androgenetic alopecia?",{"text":121,"@type":113},"No measurable clinical benefit was observed; photography showed no visible improvement, and hair density increases were small and not statistically significant, with no meaningful changes in terminal/vellus ratio, shaft diameter, or pull test.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},439029,1791162563,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39,"preview_page_count":4},1374391974585,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Journal of Cosmetic Dermatology  \nLETTER  OPEN ACCESS   \nTopical 4-Aminopyridine 5% in Male Androgenetic Alopecia: A Split-Scalp Exploratory Series  \nNicolò Rivetti  | Claudio Zeccara  \nDermatology Outpatient Clinic, Istituto Clinico Beato Matteo, Gruppo San Donato, Vigevano, Italy Correspondence: Nicolò Rivetti ([rivetti.nicolo@gmail.com](rivetti.nicolo@gmail.com))  \nReceived: 6 October 2025 | Revised: 18 December 2025 | Accepted: 30 December 2025  \nAndrogenetic alopecia (AGA) is the most common form of hair loss in men, affecting up to 80% of individuals during their lifetime [1] . Current FDA-approved therapies, namely topical minoxidil and oral finasteride, can slow disease progression but do not induce de novo folliculogenesis [1] . Novel regenerative approaches are therefore of growing interest.  \n4-Aminopyridine (4-AP) is a voltage-gated potassium channel blocker approved for multiple sclerosis. In murine wound models, 4-AP has consistently promoted tissue regeneration: systemic administration accelerated closure and induced de novo folliculogenesis in excisional wounds [2], topical delivery improved burn healing with enhanced re-epithelialization and follicle formation [3], and systemic treatment further facilitated burn repair by modulating inflammation, apoptosis, angiogenesis, and extracellular matrix remodeling [4] . Based on this rationale, we conducted a split-scalp exploratory series to assess the potential of topical 4-AP 5% in men with AGA.  \nWe included 10 male patients with AGA, mean age 35.8 years (range 22–49), Hamilton–Norwood stage I–V, who were recruited and followed from January 2025 to May 2025. All had been on stable topical and/or oral minoxidil for ≥12 months. Patients on finasteride or dutasteride were excluded. Each patient underwent eight sessions of microneedling (dermaroller 1.5 mm, passes until pinpoint bleeding) at 2-week intervals for 4 months. On the left scalp, 2 mL of a galenic 4-AP 5% solution was applied; on the right scalp, 2 mL of saline served as intrapatient control. Post-treatment care included betadine disinfection and avoidance of minoxidil for 24 h. Clinical efficacy was assessed at baseline and after 4 months using global photography and standardized trichoscopy at four fixed scalp sites (temporal angle, baihui acupoint, hair whorl, and occipital tuberosity), as  \ndescribed by Wang et al. [5], Trichoscan analysis (hair density, shaft diameter, terminal/vellus ratio), and pull test.  \nAll 10 patients completed the study with topical 4-AP 5% solution, and no adverse events were reported. Global photography showed no visible improvement in density or hair caliber. Trichoscopy/Trichoscan revealed a mean hair density increase of +1.2 hairs/cm2 on the 4-AP side vs. +0.8 hairs/cm2 on the saline side (NS), with no significant changes in terminal-to-vellushair ratio or mean shaft diameter. The pull test remained unchanged. Representative images from two patients are shown in Figure 1, while patient characteristics and outcomes are summarized in Table 1.  \nIn our exploratory series, topical 4-AP 5% did not show measurable benefit in male AGA. Notably, the beneficial effects reported in animal studies were observed in the setting of skin wounds. In mice, 4-AP accelerated closure and induced de novofolliculogenesis in excisional wounds [2], improved healing and follicle formation in burn injuries when delivered topically [3], and enhanced burn repair when administered systemically through modulation of inflammation, apoptosis, angiogenesis, and extracellular matrix remodeling [4]. The difference between these regenerative wound-healing contexts and the androgendriven follicular miniaturization of AGA may help to explain why the effects of 4-AP did not translate into clinical benefit. Our findings therefore highlight a translational gap between wound-healing–associated regeneration and androgenetic alopecia, underscoring the need for cautious extrapolation from preclinical models to human ","cbCaim5nGQ5t2mJf","https://ap.wps.com/l/cbCaim5nGQ5t2mJf","pdf",408955,"English","# Background\n# Study design and methods\n## Participants and interventions\n## Outcome assessment\n# Results\n# Discussion and limitations","[{\"question\":\"What treatment was tested in the split-scalp exploratory series?\",\"answer\":\"Topical 4-aminopyridine (4-AP) 5% was applied to one scalp side, paired with saline as an intrapatient control on the other side, after microneedling sessions.\"},{\"question\":\"How were patients assessed for efficacy over the study period?\",\"answer\":\"Efficacy was evaluated at baseline and after four months using global photography and standardized trichoscopy/Trichoscan at fixed scalp sites, plus hair pull testing.\"},{\"question\":\"Did topical 4-AP 5% show measurable benefit for male androgenetic alopecia?\",\"answer\":\"No measurable clinical benefit was observed; photography showed no visible improvement, and hair density increases were small and not statistically significant, with no meaningful changes in terminal/vellus ratio, shaft diameter, or pull test.\"}]","Topical 4-Aminopyridine 5% in Male Androgenetic Alopecia - A Split-Scalp Exploratory Series | PDF",1790687227]