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Pumpkin Seed Oil vs. Minoxidil 5% Topical Foam for the Treatment of Female
Pattern Hair Loss: A Randomized Comparative Trial

Article  in  Journal of Cosmetic Dermatology · February 2021

DOI: 10.1111/jocd.13976

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Received: 6 November 2020    Revised: 4 January 2021    Accepted: 22 January 2021

DOI: 10.1111/jocd.13976

ORIGINAL CONTRIBUTION

Pumpkin seed oil vs. minoxidil 5% topical foam for the

treatment of female pattern hair loss: A randomized
comparative trial

Ibrahim M. Ibrahim MD1 | Mohamed S. Hasan MD1 | Khaled I. Elsabaa MSc1 |

Mohamed L. Elsaie MD2

1
Department of Dermatology, Al-­A zhar
University, Cairo, Egypt
2
Department of Dermatology, National
Research Centre, Cairo, Egypt
Correspondence
Mohamed L. Elsaie, Department of
Dermatology, National Research Centre,
Nasr City 11371, Cairo, Egypt.
Email: Egydoc77@yahoo.com
Abstract
Background: Pumpkin (Cucurbita pepo L.) is an annual climber plant, and its seeds
have considerable amount of oil with nutritional and medicinal importance.
Aim: The present study aimed to investigate the clinical efficacy of pumpkin seed oil
(PSO) in the treatment of female pattern hair loss (FPHL) and compare its effects with
minoxidil 5% foam.
Methods: Patients with FPHL were randomly assigned to pumpkin seed oil (n = 30;
group A) or minoxidil 5% foam (n = 30; group B) for a period of 3 months. Patients
were evaluated clinically and dermoscopically at baseline, at one and half months,
and at the end of the 3-­month study.
Results: Among group A (pumpkin seed oil) candidates, a significant decrease was
observed in hair shaft diversity before and after treatment (30.5 ± 6.2%, 24.0 ± 4.02,
P < .001, respectively) as well as in the vellus hairs (22.5 ± 4.9, 15.8 ± 2.2, P < .001,
respectively). Upright regrowing hairs significantly increased from (0.13 ± 0.5) before
treatment to (0.9 ± 1.0) after treatment (P < .001). In group B (minoxidil applying)
candidates, a significant decrease was observed in hair shaft diversity before and
after treatment (31.5 ± 6.3%, 21.3 ± 2.2, P  < .001, respectively) as well as in the
vellus hairs (24.7 ± 6.4, 19.5 ± 5.4, P = .02, respectively). Conclusion Findings of the
present trial provide evidence of a promising potential role of PSO in treating FPHL.

KEYWORDS

dermoscopy, female pattern hair loss, minoxidil, pumpkin seed oil

1 |  I NTRO D U C TI O N
Female pattern hair loss (FPHL) is a prevalent hair disorder in fe-
males. It usually starts at puberty with a progressive nonscarring
miniaturization of the hair follicle, with a characteristic pattern and
1
distribution, that occurs in genetically predisposed women.
Despite that FPHL peaks up after puberty, it can still appear in
younger ages. It involves the vertex, upper parietal scalp, and the
fronto-­parietal areas with a characteristic preservation of the frontal
hairline and less miniaturization in comparison with male pattern hair
loss (MPHL). 2
Clinical examination and inspections remain to be the golden di-
agnostic standard along with other detection tools that aids in distin-
guishing FPHL from other hair pathologies.3
Dermoscopy is a tool that helps with early diagnosis of FPHL and
differentiating it from other hair loss conditions. Discrepancies and
heterogenicity in the hair shaft thickness are hallmark features seen
by dermoscopy in FPHL.4 Other criteria include increased vellus

J Cosmet Dermatol. 2021;00:1–7. wileyonlinelibrary.com/journal/jocd© 2021 Wiley Periodicals LLC     1 |

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2       IBRAHIM et al.

hairs (decreased terminal to vellus hair ratio), predominance of hair 2.2 | Inclusion criteria
follicular units with single hairs as well as yellow spots (hair follicles
filled with hyperkeratotic plugs).4 • Female patients with type 1 and 2 hair loss according to the
In recent years, a variety of plant extracts and botanicals had been Ludwig classification of female pattern hair loss (Ludwig, 1977).12
implicated in hair loss treatment. Serenoa repens, Pygeum africanum, • The age from 18 to 50 years.
Urtica dioica, Camellia sinensis, and polyphenols in green tea exhib-
ited 5α-­reductase inhibitory effect and promoted hair growth.5,6 In
one study, oral administration of 400 mg of pumpkin seed oil (PSO) for 2.3 | Exclusion criteria
24 weeks to men with androgenic baldness increased hair growth.7
Pumpkin (Cucurbita pepo L.) is an annual climber plant, and its • Female patients with type 3 pattern according to the Ludwig clas-
seeds have considerable amount of oil with nutritional and medicinal sification of female pattern hair loss.
importance. Moreover, pumpkin has antioxidant, anti-­inflammatory, • Patients with known hypersensitivity to pumpkin seed oil or
antimicrobial, cytoprotective, and antidiabetic effects.8,9 minoxidil.
Minoxidil though approved by the FDA in 1979 for the treatment • Pregnant and lactating females.
of hypertension was found to promote hair growth in male androge- • Recent medical treatment in the last three months.
netic alopecia (AGA) when applied topically. Solutions of 2% and 5% • Any associated disease of scalp.
minoxidil were approved for treating male AGA in 1988 and 1991.
In female pattern hair loss (FPHL), only the 2% solution was FDA-­
approved for use in 1991, and recently in 2014, the 5% foam was 2.4 | Methods
FDA-­approved for a once-­daily application.1
A number of saturated and unsaturated fatty acids (UFAs) in- Patients were divided into two groups:
cluding linoleic acid, linolenic acid, palmitic acid, and others are the
chief constituents of pumpkin seed oil (PSO). Moreover, PSO con- • Group A: 30 female patients with androgenic alopecia on topical
tains beta-­sitosterol, which actively inhibits 5α-­reductase enzyme.10 pumpkin seed oil.
Raynaud et al reported that linoleic acid also has inhibitory activity • Group B: 30 female patients with androgenic alopecia on topical
against 5α-­reductase.11 minoxidil.
Based on the abovementioned researches, the current study was
designed to investigate the clinical efficacy of PSO in the treatment All patients were subjected to the following:
of FPHL and compare its effects with the very widely used minoxidil Full history taking: Demographic data such as age, onset, course,
5% topical foam. duration, and medical history.
Clinical examination: For falling hair and its pattern.
Dermoscopic examination: The follicular openings, perifollicular
2 |  PATI E NT S A N D M E TH O DS discoloration, and hair shaft thickness were dermoscopically exam-
ined using DermLite 3.
2.1 | Study population

This study was conducted on 60 female patients with androgenic al-
opecia (diagnosed clinically and dermoscopically). The patients were
recruited from the dermatology department outpatient clinic from
December 2019 to August 2020. Informed consents were taken
from all subjects before enrollment in the study and were approved
by the medical research ethics committee.
2.4.1 | Procedure
• Group A: Were instructed to apply 1 mL of topical pumpkin seed
oil once daily and for three consecutive months.
• Group B: Were instructed to apply 1 mL of minoxidil 5% foam
once daily and for three consecutive months.

TA B L E 1   Age and disease duration

Group A Group B
among both group subjects
(N = 30) (N = 30) MW P-­value

Age (y) Mean ± SD 34.3 ± 9.5 30.9 ± 9.6 347.5 .129 NS

Median 31.5 28
Duration (y) Mean ± SD 2.1 ± 1.3 2.25 ± 1.2 391 .368 NS
Median 1.75 2

Note: MW: Mann-­Whitney test. NS: P-­value  > .05 is considered nonsignificant.

IBRAHIM et al.       3|
TA B L E 2   Comparison between studied
Group A (N = 30) Group B (N = 30) χ2 P-­value
groups as regard grade, onset, and course
Grade Grade I 25 83.3% 23 76.7% 0.41 .519 NS
Grade II 5 16.7% 7 23.3%
Onset Acute 0 0% 0 0% —­ —­
Gradual 30 100% 30 100%
Course Regressive 0 0% 0 0% —­ —­
Progressive 30 100% 30 100%

Note: χ2: Chi-­square test. NS: P-­value  > .05 is considered nonsignificant.

2.5 | Follow-­up and statistical analysis
Following the initial diagnostic visit, patients were followed up
using clinical and dermoscopic evaluation, one and half months
into the treatment and at 3 months following the start of treat-
ment. The results were tabulated and statistically analyzed
using Statistical Program for Social Science (SPSS) version 15.0.
Quantitative data were expressed as mean ± standard deviation
(SD), median, and IQR. Qualitative data were expressed as fre-
quency and percentage.
3 | R E S U LT S
In the present study, the mean age of studied patients in group A
was 34.3 ± 9.5 years and 30.9 ± 9.6 years for group B (P = .129). The
mean duration of FPHL in the studied patients was 2.1 ± 1.3 years
for group A and 2.25 ± 1.2 years for group B (P = .368). Table 1.
According to the Ludwig classification, 83.3% (25/30) of patients
in group A were grade 1 and 16.7% (5/30) were grade 2. Regarding
group B, 76.7% (23/30) of patients were grade 1 and 23.3% (7/30)
were grade 2. The distribution of type 1 and type 2 FPHL in both
groups was of no significance (P = .519). In all patients, the hair loss
had an acute onset and a progressive course (Table 2).
Dermoscopic evaluation of hair shaft diversity, vellus hairs, up-
right regrowing hairs, yellow dots, and peripilar signs among both
groups before treatment showed no significant difference (P > .05)
(Table 3).
Among group A (pumpkin seed oil) candidates, a significant de-
crease was observed in hair shaft diversity before and after treat-
ment (30.5 ± 6.2%, 24.0 ± 4.02, P  < .001, respectively) as well as
in the vellus hairs (22.5 ± 4.9, 15.8 ± 2.2, P  < .001, respectively).
Upright regrowing hairs significantly increased from (0.13 ± 0.5) be-
fore treatment to (0.9 ± 1.0) after treatment (P < .001). No signifi-
cant decrease was observed in yellow dots and peripilar sign before
(1.16 ± 2.2 and 29.3 ± 23.6) and after (0.9 ± 1.8 and 29.3 ± 23.6)
treatment (P > .05) (Table 4).
In group B (minoxidil applying) candidates, a significant decrease
was observed in hair shaft diversity before and after treatment
(31.5  ± 6.3%, 21.3 ± 2.2, P  < .001, respectively) as well as in the
vellus hairs (24.7 ± 6.4, 19.5 ± 5.4, P  = .02, respectively). Upright
regrowing hairs significantly increased from (0.13 ± 0.5) before
treatment to (2.03 ± 1.6) after treatment (P < .001). No significant
decrease was observed in yellow dots and peripilar sign before
(1.10 ± 2.5 and 28.2 ± 18.7) and after (1.0 ± 2.3 and 28.2 ± 18.7)
treatment (P > .05) (Table 5).
Following treatment, dermoscopic evaluation demonstrated a
more significant decrease in hair shaft diversity among group B (mi-
noxidil applying) candidates compared with group A (PSO applying)
candidates (P = .004) as well as a significantly increased number of
regrowing hairs (P = .005) and a more significant decrease in vellus
hairs compared with those applying PSO (P = .004) (Table 6).

TA B L E 3   Dermoscopic changes
Group A Group B
between both groups before treatment
Dermoscopy before (N = 30) (N = 30) MW P-­value

Hair shaft diversity Mean ± SD 30.5 ± 6.2 31.5 ± 6.3 404 .465 NS

Median 30 30
Yellow dots Mean ± SD 1.16 ± 2.2 1.1 ± 2.5 436.5 .782 NS
Median 0.0 0.0
Peripilar sign Mean ± SD 29.3 ± 23.6 28.2 ± 18.7 436.5 .839 NS
Median 30 30
Vellus hair Mean ± SD 22.5 ± 4.9 24.7 ± 6.4 353.5 .132 NS
Median 20 25
Upright regrowing Mean ± SD 0.13 ± 0.5 0.13 ± 0.5 450 1.0 NS
hair Median 0.0 0.0

Note: MW: Mann-­Whitney test. NS: P-­value  > .05 is considered nonsignificant.

 |
4       IBRAHIM et al.

TA B L E 4   Dermoscopic changes
Before After
among group A subjects before and after
Group A (N = 30) (N = 30) MW P-­value
treatment
Hair shaft diversity Mean ± SD 30.5 ± 6.2 24.0 ± 4.02 174.5 <.001 HS
Median 30 25
Yellow dots Mean ± SD 1.16 ± 2.2 0.9 ± 1.8 438.5 .818 NS
Median 0.0 0.0
Peripilar sign Mean ± SD 29.3 ± 23.6 29.3 ± 23.6 450 1.0 NS
Median 30 30
Vellus hair Mean ± SD 22.5 ± 4.9 15.8 ± 2.2 92.5 <.001 HS
Median 20 15
Upright regrowing Mean ± SD 0.13 ± 0.5 0.9 ± 1.0 233 <.001 HS
hair Median 0.0 1

Note: MW: Mann-­Whitney test. HS: P-­value  < .001 is considered highly significant.
NS: P-­value  > .05 is considered nonsignificant.
Bold values are Highly significant (HS).

TA B L E 5   Dermoscopic changes
Before After
among group B subjects before and after
Group B (N = 30) (N = 30) MW P-­value
treatment
Hair shaft diversity Mean ± SD 31.5 ± 6.3 21.3 ± 2.2 69 <.001 HS
Median 30 20
Yellow dots Mean ± SD 1.1 ± 2.5 1.0 ± 2.3 446.5 .941 NS
Median 0.0 0.0
Peripilar sign Mean ± SD 28.2 ± 18.7 28.2 ± 18.7 450 1.0 NS
Median 30 30
Vellus hair Mean ± SD 24.7 ± 6.4 19.5 ± 5.4 243 .002 S
Median 25 20
Upright regrowing Mean ± SD 0.13 ± 0.5 2.03 ± 1.6 142 <.001 HS
hair Median 0.0 2

Note: MW: Mann-­Whitney test. S: P-­value  < .05 is considered significant. HS: P-­value  < .001 is
considered highly significant. NS: P-­value  > .05 is considered nonsignificant.
Bold values are Highly significant (HS).

TA B L E 6   Dermoscopic changes among

Group A Group B
both groups after treatment
Dermoscopic changes (N = 30) (N = 30) MW P-­value

Hair shaft diversity Mean ± SD 24.0 ± 4.02 21.3 ± 2.2 280 .004 S

Median 25 20
Yellow dots Mean ± SD 0.9 ± 1.8 1 ± 2.3 440 .837 NS
Median 0.0 0.0
Peripilar sign Mean ± SD 29.3 ± 23.6 28.2 ± 18.7 436.5 .839 NS
Median 30 30
Vellus hair Mean ± SD 15.8 ± 2.2 19.5 ± 5.4 262.5 .004 S
Median 15 20
Upright regrowing Mean ± SD 0.9 ± 1.0 2.03 ± 1.6 268 .005 S
hair Median 1 2

Note: MW: Mann-­Whitney test. S: P-­value  < .05 is considered significant. NS: P-­value  > .05 is
considered nonsignificant.
Bold values are Highly significant (HS).
IBRAHIM et al. |
      5

F I G U R E 1   Female patient 23 y old

complaining of diffuse hair loss of 1-­year
clinical image (A) shows diffuse thinning
of the hair in the middle of the scalp
with preserved frontal hairline (grade 1
according to the Ludwig classification of
FPHL). Dermoscopy of first visit (DermLite
3 gen 10×) (B) shows hair shaft diversity
(blue arrows), peripilar sign (rectangle)
suggestive for androgenic alopecia, clinical
photograph after three months of follow-­
up (C). Dermoscopy after three months
of minoxidil therapy (D) shows increased
diameter of hair shafts and decreased hair
shaft diversity with presence of upright
regrowing hair (circle).

(A) (C)

(B) (D)

4 | D I S CU S S I O N Another single-­blinded comparative study demonstrated that

Botanical preparations have gained an increasing recent interest in
the treatment of many skin disorders among which are hair disor-
13
ders including alopecias. The following study was designed to in-
vestigate the clinical efficacy of PSO in the treatment of FPHL and
compare its effects with the widely prescribed minoxidil 5% topical
foam (Figures 1 and 2).
Pumpkin (Cucurbita pepo) belongs to the squash family and is rich
in phytosterols that actively inhibits the conversion of testosterone
to dihydrotestosterone (DHT).14,15 One study compared the use of
oral daily 400mgs of PSO to oral placebo in 76 patients with AGA
and demonstrated a 40% increase in hair count among pumpkin seed
oil users.7
sesame and pumpkin seed oil are new safe effective treatment mo-
dalities for alopecia areata with no statistically significant superior-
ity to one another.16
To our knowledge, no study has yet specifically investigated the
efficacy of pumpkin seed oil in the treatment of FPHL. An animal
model study reported that topical application of PSO reversed the
testosterone-­induced retarded hair growth in mice.17 It was specu-
lated that PSO exerts an anti-­androgen effect on both prostate and
hair follicles making it effective in treating benign prostatic hyper-
plasia (BPH) and hair loss in animal models. Whether this effect is
mediated via inhibition of 5α-­reductase or as an antagonistic effect
at androgen receptors, is not clear and further investigations are
needed.17,18
 |
6       IBRAHIM et al.
(A) (C)
(B) (D)
Pumpkin seed oil is a rich source of unsaturated fatty acids, es-
pecially oleic acid and linoleic acid. Such essential acids are reported
to inhibit 5α-­reductase, and hence, they might contribute to its hair
growth potential via their anti-­androgen effects.14
Limitations of the trial included the small number of the study
population and the relatively short period of follow-­up. Moreover,
there was no histological confirmation of the hair changes no bio-
chemical evaluation of DHT to assess its impact on AGA and its cor-
relation to PSO use.
5 |  CO N C LU S I O N
The current study revealed significant improvement in both groups
regarding hair shaft diversity, vellus hair, and upright regrowing hair.
There was no difference in peripilar sign or yellow dots. Minoxidil
F I G U R E 2   Female patient 26 y
old complaining of diffuse hair loss of
1-­y duration clinical image (A) shows
diffuse thinning of the hair in the middle
of the scalp with preserved frontal
hairline (grade 1 according to Ludwig
classification of FPHL). Dermoscopy
of first visit (DermLite 3 gen 10×) (B)
shows hair shaft diversity (blue arrows),
suggestive for androgenic alopecia,
clinical photograph after three months
of follow-­up (C). Dermoscopy after three
months of pumpkin seed oil therapy (D)
shows increases diameter of hair shafts
and decreases hair shaft diversity with
presence of upright regrowing hair (circle)
and vellus hairs (rectangle).
exhibited a higher significant efficacy to PSO and remains to be the
gold standard treatment in FPHL. Moreover, the findings of the pre-
sent trial provide evidence with respect to the efficacy of PSO oil in
the treatment of FPHL. Further research is warranted to identify the
active ingredients and their mechanism of action.
DATA AVA I L A B I L I T Y S TAT E M E N T
Available upon request from authors.
ORCID
Mohamed L. Elsaie  https://orcid.org/0000-0001-7541-5241
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How to cite this article: Ibrahim IM, Hasan MS, Elsabaa KI,
Elsaie ML. Pumpkin seed oil vs. minoxidil 5% topical foam for
the treatment of female pattern hair loss: A randomized
comparative trial. J Cosmet Dermatol. 2021;00:1–­7.
https://doi.org/10.1111/jocd.13976