"Personalized Minoxidil Therapy in Androgenetic Alopecia: From SULT1A1 Biomarkers to Precision Clinical Management".

Androgenetic alopecia (AGA) is the most common cause of progressive hair loss, affecting millions of people all around the world and having a considerable psychological, social, and economic impact. Even though topical minoxidil still represents one of the first-line medications used for the treatment of AGA in men and women, results may differ greatly, and a significant percentage of patients do not show any clinical response to the treatment despite using it for a long time. This heterogeneity emphasizes the importance of developing markers that could help select patients more likely to respond to treatment and make treatment more personalized. Follicular sulfotransferase family 1A member 1 (SULT1A1), an enzyme that catalyzes the conversion of minoxidil to a biologically active sulfate metabolite, is the best-studied marker of topical minoxidil responsiveness. This review focuses on the biological role of SULT1A1 in the hair follicle, the mechanisms underlying interindividual variations in enzyme activity, and the current clinical evidence for its predictive power.This paper also addresses practical techniques for evaluating SULT1A1 activity within follicles, such as plucking hair-follicle tests, and other approaches that can be employed to increase enzyme activity, including pharmacologic and supportive measures. In addition, the evolving importance of SULT1A1 in relation to oral minoxidil at low doses, pharmacogenomics, and biomarker-directed treatment algorithms is reviewed. Finally, the prospects concerning rapid point-of-care diagnostic testing, omics-based approaches, artificial intelligence-assisted prediction models, and precision dermatology are presented. Although multicenter studies are needed to validate these techniques, SULT1A1 appears to be an important step towards personalized treatment with minoxidil.