Oral minoxidil proven safe, effective for treating alopecia

Use of low-dose oral minoxidil is safe and effective in the treatment of androgenic alopecia (AGA) and alopecia areata (AA), in addition to demonstrating a big advantage over the topical formulation in terms of convenience and patient compliance, as reported in a systematic review.

Researchers searched multiple electronic databases for relevant studies and identified 10 articles for the final review, of which four were prospective studies, three were retrospective studies, and three were case reports. The total study population included 19,218 patients with alopecia (98.9 percent male).

Low-dose oral minoxidil therapy was used for a variety of alopecic types including male and female AGA in four studies (n=19,079), AA in two studies (n=99), chronic telogen effluvium (CTE) in one study (n=36), monilethrix in one study (n=2), chemotherapy-induced alopecia (CIA) in one study (n=1), and loose anagen hair syndrome (LAHS) in one study (n=1). Dose ranged from 0.25 to 5 mg daily and twice daily.

The strongest evidence existed for AGA and AA, with 61–100 percent and 18–82.4 percent of patients in the respective groups demonstrating objective clinical improvement. The drug also proved successful in treating female pattern hair loss, chronic telogen effluvium, monilethrix, and permanent chemotherapy‐induced alopecia.

The most common adverse effects were hypertrichosis and postural hypotension.

With regard to the clinical decision of choosing between oral and topical therapy, a recent editorial outlined the five C’s of oral minoxidil: convenience, cosmesis, cost-savings, co-therapy, and compliance. The oral route of administration would factor in patients with severe hair loss with a surface area too large for topical coverage alone, multiple topical regimens used, or difficult synchronization with bathing and activity schedules. Furthermore, treatment compliance might be more readily achieved with a daily systemic medication vs topical therapy. [Dermatol Ther 2018;31:e12707]

Finally, oral minoxidil has proved valuable in treating complicated, refractory cases of alopecia, inducing clinically significant hair regrowth in patients who failed first-line therapy. [Australas J Dermatol 2018;59:e286-e287]