Perifollicular Fibrosis in Androgenetic Alopecia

This narrative review explores the role of perifollicular fibrosis in androgenetic alopecia (AGA), highlighting its impact on hair regrowth and treatment efficacy. The review discusses the pathophysiology involving androgen-driven profibrotic signaling, TGF-β activation, and chronic microinflammation, which contribute to collagen deposition and dermal sheath thickening, creating barriers to follicular regeneration. Conventional treatments like minoxidil and 5-alpha-reductase inhibitors show limited antifibrotic effects in advanced cases. Promising therapeutic strategies include anti-inflammatory approaches, microneedling, platelet-rich plasma, regenerative cell therapies, and targeting TGF-β and CXCL12. However, robust randomized controlled trials are needed to validate these antifibrotic strategies, with future research focusing on combination therapies addressing both androgen signaling and fibrotic pathways.