Amla Improves Symptoms of Hair Loss in Female Androgenic Alopecia (FAGA)

Written by Chrystal Moulton, Staff Writer. Researchers saw a significant improvement in anagen and telogen percentage as well as anagen to telogen ratio in patients assigned the test syrup compared to placebo.

Amla, also known scientifically as Phyllanthus emblica L., is a traditional remedy in Persian medicine used to treat and prevent hair loss¹. Amla contains mosaic acid, amino acids, tannins, and various other phytochemical compounds and nutrients². Female androgenetic alopecia (FAGA) is a common cause of non-scarring hair loss in women that is non-life threatening but associated with psychological burden and negatively impacting interpersonal and social relationships, self-confidence, and quality of life^3,4. Although in vivo trials have shown a positive effect Amla on hair growth and prevention of hair loss, no clinical trial has been conducted to assess amla fruit on female androgenetic alopecia (FAGA)⁵. In the current trial, researchers studied the effect of Amla syrup on female androgenetic alopecia (FAGA)⁵.

The study was designed as a randomized, placebo-controlled, triple blind study. Neither the researcher, the data analyst, or the patient were aware of the randomization and assigned codes. The Ludwig scale was used for grading FAGA. According to the Ludwig scale, there are three stages of FAGA⁵:

1. Stage 1-mild decrease in hair density on the crown with hardly noticeable increase in part width
2. Stage 2-moderate decrease in your density on the crown with perceptible increase in part width
3. Stage 3-severe decrease in hair density on the crown with no perceptible part width and thinning of the frontal hairline

Women with FAGA, between the age of 18 and 60 years old, were recruited for this trial. Participants had to have more than six months duration with types one and two hair loss according to Ludwig scoring. Both the intervention and the placebo were prepared as a syrup. The test product, Amla syrup, was prepared using 30 grams of Amla fruit coarsely ground and boiled in water for 30 minutes and then mixed with rose water to improve taste and smell. The placebo was made using 100 grams of honey added to water then boiled. Rose water was also added at the end. Both placebo and test syrup matched in color. Participants in both the intervention and placebo group were instructed to take 10 mL of syrup three times a day for 12 weeks. Hair loss was measured using a TrichoScan at baseline and after 12 weeks. The Clinical Global Impression of Improvement scale (CGI-I) and Patient Global Impression of Improvement Questionnaire (PGI-I) were used to assess physician and patient satisfaction at the end of the 6th and 12th week, respectively.  Researchers also tested the total phenolic and flavonoid content of the Amla syrup used in the trial. Microbial test was conducted to ensure safety of the syrups. Adverse events were checked during follow up calls once every two weeks.

No significant difference was observed between the intervention and placebo group in parameters of hair loss and growth as well as demographics. At the end of the trial, researchers saw a significant improvement in anagen percentage (F= 24.7, p<0.001), telogen percentage (F= 12.6, p<0.001), and anagen to telogen ratio (F= 10.4, p<0.002) in patients assigned the test syrup compared to placebo. Researchers also observed a significant improvement in patient and physician satisfaction after 12 weeks supplementation with the Amla syrup (see Table 1). The only side effect reported was a single case of constipation in one participant using the test syrup which was remedied with dietary recommendations.

Table 1. Result of 12week intake of Amla vs. placebo syrup

In the end, Amla syrup significantly increased the anagen to telogen phase ratio in women with FAGA compared to placebo. Additional studies will be needed to verify these results and compare to existing treatments for female androgenetic alopecia.

Source: Akhbari, Marzieh, Alireza Firooz, Roja Rahimi, Meysam Shirzad, Niusha Esmaealzadeh, and Laila Shirbeigi. “The effect of an oral product containing Amla fruit (Phyllanthus emblica L.) on female androgenetic alopecia: A randomized controlled trial.” Journal of Ethnopharmacology 318 (2024): 116958.

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Posted November 14, 2023.

Chrystal Moulton BA, PMP, is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Indianapolis, IN.

References:

1. Hajimehdipoor H, Nikmanesh N, Mohammadi-Motamed M. Amla oil, a pharmaceutical product based on traditional knowledge for alopecia treatment. Res J Pharmacogn. 2019;6(1):57-61.
2. Saini R, Sharma N, Oladeji OS, et al. Traditional uses, bioactive composition, pharmacology, and toxicology of Phyllanthus emblica fruits: A comprehensive review. J Ethnopharmacol. Jan 10 2022;282:114570. doi:10.1016/j.jep.2021.114570
3. Russo PM, Fino E, Mancini C, Mazzetti M, Starace M, Piraccini BM. HrQoL in hair loss-affected patients with alopecia areata, androgenetic alopecia and telogen effluvium: the role of personality traits and psychosocial anxiety. J Eur Acad Dermatol Venereol. Mar 2019;33(3):608-611. doi:10.1111/jdv.15327
4. Carmina E, Azziz R, Bergfeld W, et al. Female Pattern Hair Loss and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee. The Journal of clinical endocrinology and metabolism. Jul 1 2019;104(7):2875-2891. doi:10.1210/jc.2018-02548
5. Akhbari M, Firooz A, Rahimi R, Shirzad M, Esmaealzadeh N, Shirbeigi L. The effect of an oral product containing Amla fruit (Phyllanthus emblica L.) on female androgenetic alopecia: A randomized controlled trial. J Ethnopharmacol. Jan 10 2024;318(Pt A):116958. doi:10.1016/j.jep.2023.116958