Top

20-11-2023 | Minoxidil | HOT TOPIC

Oral Minoxidil Therapy in Hair Loss: Where Do We Stand?

Author: Ghadah Alhetheli

Published in: Current Dermatology Reports

Abstract

Purpose of Review

This review is aimed at elucidating the efficacy and safety of oral minoxidil (OM) for the treatment of hair loss (HL), especially androgenic alopecia (AGA), and at highlighting its future applications. A comprehensive review of the published literature concerning the management of various types of non-scarring HL was performed. The review focused on the therapeutic role of minoxidil (MNX) in HL for both sexes and various age groups.

Recent Findings

Recent studies suggested the effectiveness of OM in the dose range of 0.625–2.5 mg daily and in male pattern hair loss (MPHL), with gradual increase up to 5 mg/day. Low-dose OM (LDOM) showed effectiveness in various types of HL in both sexes and in pediatric patients. OM was more advantageous than topical MNX because it was more convenient, cost-effective, and compliant with the application of adjuvant co‐therapy. Five α-reductase inhibitors offer an effective treatment for HL but are associated with male sexual dysfunction. Oral MNX surpassed 5α-reductase inhibitors regarding effectiveness in addition to its vasodilator effect, which improves male sexual function.

Summary

OM could be considered a convenient and safe therapy for various types of HL, specifically AGA. LDOM could be appropriate for pediatric age groups and patients intolerant to hypertrichosis. Since OM can improve erectile function, it is more convenient for male patients.

Harrison S, Piliang M, Bergfeld W, et al. Hair disorders. In: Cleveland Clinic, ed. Current Clinical Medicine (Second Edition). Second Edi. Philadelphia: W.B. Saunders; 2010:289–293.e1. https://doi.org/10.1016/B978-1-4160-6643-9.00042-4.

Nilforoushzadeh MA, Golparvaran M. YekaninejadMS: Assessment of quality of life and self-esteem in male patients with androgenetic alopecia before and after hair transplantation. J Cosmet Dermatol. 2023;22(8):2283–7. https://doi.org/10.1111/jocd.15716. CrossRefPubMed

Wang G, Wang Z, Shen Y, Hou X, Su L, Chen W, et al. Treatment of androgenetic alopecia by exosomes secreted from hair papilla cells and the intervention effect of LTF. J Cosmet Dermatol. 2023. https://doi.org/10.1111/jocd.15873. CrossRefPubMed

•• Li K, Sun Y, Liu S, Zhou Y, Qu Q, Wang G, et al. The AR/miR-221/IGF-1 pathway mediates the pathogenesis of androgenetic alopecia. Int J Biol Sci. 2023;19(11):3307–3323. https://doi.org/10.7150/ijbs.80481. This found that miR-221 significantly suppressed hair growth and the proliferation of dermal papilla cells and dermal sheath cells in AGA patients. Interestingly, miR-221 and AR were mainly co-located in the same part of the hair follicle, making it a novel biomarker and potential therapeutic target for treating AGA.

Zhao B, Li J, Chen Q, Yang N, Bao Z, Hu S, et al. A treatment combination of IGF and EGF promotes hair growth in the Angora rabbit. Genes (Basel). 2020;12(1):24. https://doi.org/10.3390/genes12010024. CrossRefPubMed

Willems A, Sinclair R. Alopecias in humans: Biology, pathomechanisms and emerging therapies. Vet Dermatol. 2021;32(6):596-e159. https://doi.org/10.1111/vde.13014. CrossRefPubMed

Redmond L, Limbu S, Farjo B, Messenger A, Higgins C. Male pattern hair loss: Can developmental origins explain the pattern? Exp Dermatol. 2023. https://doi.org/10.1111/exd.14839. CrossRefPubMed

Olsen EA. Female pattern hair loss. J Am Acad Dermatol. 2002;45:S70–80. CrossRef

Ramos PM, Miot HA. Female pattern hair loss: A clinical and pathophysiological review. An Bras Dermatol. 2015;90(4):529–43. CrossRefPubMedPubMedCentral

10.

Ramos P, Melo D, Radwanski H, De Almeida R, Miot H. Female pattern hair loss: Therapeutic update An Bras Dermatol. 2023;S0365–0596(23):00053–63. https://doi.org/10.1016/j.abd.2022.09.006. CrossRef

11.

Jimenez-Cauhe J, Saceda-Corralo D, Rodrigues-Barata R, Hermosa-Gelbard A, Moreno-Arrones OM, Fernandez-Nieto D, et al. Effectiveness and safety of low-dose oral minoxidil in male androgenetic alopecia. J Am Acad Dermatol. 2019;81:648–9. CrossRefPubMed

12.

• Lemes LR, Melo D, De Oliveira D, De La-Rocque M, Zompero C, Ramos P. Topical and oral minoxidil for hair disorders in pediatric patients: What do we know so far? Dermatol Ther. 2020; 33(6):e13950. https://doi.org/10.1111/dth.13950. This article pointed out the use of minoxidil in several pediatric hair diseases. Even when used topically, dermatologists should be aware of potential risks of systemic absorption. In particular situations, OMX in very low doses may be considered. To date, there are no guidelines regarding the ideal dose or minimum age for using the drug topically or systemically.

13.

Verma K, Tegta GR, Verma G, Gupta M, Negi A, Sharma R. A study to compare the efficacy of platelet-rich plasma and minoxidil therapy for the treatment of androgenetic alopecia. Int J Trichology. 2019;11(2):68–79.

14.

Goren A, McCoy J, Prodrugs L. In European handbook of dermatological treatments. Katsambas AD, Lotti TM, Dessinioti C, D’Erme AM (eds.) Springer, Berlin, Heidelberg 2015.

15.

Bansal S, Lau A. Human liver cytosolic sulfotransferase 2A1-dependent dehydroepiandrosterone sulfation assay by ultra-high performance liquid chromatography-tandem mass spectrometry. J Pharm Biomed Anal. 2016;20(120):261–9. https://doi.org/10.1016/j.jpba.2015.12.029. CrossRef

16.

Goto R, Oaku Y, Sasak F, Kubota C, Deguchi S, Kadowaki R, et al. Effects of skin environmental changes by steam towel, ethanol, l-menthol and carpronium on the drug behavior in the minoxidil nanoparticles-applied mice. Yakugaku Zasshi. 2022;142(9):1015–20. https://doi.org/10.1248/yakushi.22-00103. CrossRefPubMed

17.

Kikuchi S, Fujita Y, Onodera M, Fujino Y, Inoue Y. Prolonged hypotension induced by ingesting a topical minoxidil solution: Analysis of minoxidil and its metabolites. Acute Med Surg. 2016;3(4):384–7. https://doi.org/10.1002/ams2.196. CrossRefPubMedPubMedCentral

18.

Anderson R, Kudlacek P, Clemens D, et al. Sulfation of minoxidil by multiple human cytosolic sulfotransferases. Chem Biol Interact. 1998;109(1–3):53–67. https://doi.org/10.1016/s0009-2797(97)00120-8. CrossRefPubMed

19.

Goren A, Sharma A, Dhurat R, Shapiro J, Sinclair R, Situm M, et al. Low-dose daily aspirin reduces topical minoxidil efficacy in androgenetic alopecia patients. Dermatol Ther. 2018;31(6):e12741. https://doi.org/10.1111/dth.12741.

20.

• Jimenez-Cauhe J, Saceda-Corralo D, Rodrigues-Barata R, Moreno-Arrones OM, Ortega-Quijano D, Fernandez-Nieto D, et al. Safety of low-dose oral minoxidil treatment for hair loss. A systematic review and pooled-analysis of individual patient data. Dermatol Ther. 2020;33:e14106. This systematic review and pooled-analysis showed low dose OM is a safe and well-tolerated treatment for hair loss with a lower adverse effect rate than standard doses.

21.

Modha J, Pathania Y. Comprehensive review of oral minoxidil in alopecia. J Cosmet Dermatol. 2022;21(11):5527–31. https://doi.org/10.1111/jocd.15324. CrossRefPubMed

22.

Gupta AK, Talukder M, Venkataraman M, Bamimore MA. Minoxidil: A comprehensive review. J Dermatolog Treat. 2022;33(4):1896–906. https://doi.org/10.1080/09546634.2021.1945527. CrossRefPubMed

23.

Ramírez-Marín HA, Tosti A. Role of oral minoxidil in patterned hair loss Indian Dermatol Online J. 2022;13(6):729–33. https://doi.org/10.4103/idoj.idoj_246_22. CrossRefPubMed

24.

Jha AK, Sonthalia S, Zeeshan MD, Vinay K. Efficacy and safety of very-low-dose oral minoxidil 1.25 mg in male androgenetic alopecia. J Am Acad Dermatol. 2020;83:1491–3.

25.

Pirmez R, Salas-Callo CI. Very-low-dose oral minoxidil in male androgenetic alopecia: A study with quantitative trichoscopic documentation. J Am Acad Dermatol. 2020;82:e21–2. CrossRefPubMed

26.

Randolph M, Tosti A. Oral minoxidil treatment for hair loss: A review of efficacy and safety. J Am Acad Dermatol. 2021;84(3):737–46. https://doi.org/10.1016/j.jaad.2020.06.1009. CrossRefPubMed

27.

Panchaprateep R, Lueangarun S. Efficacy and safety of oral minoxidil 5 mg once daily in the treatment of male patients with androgenetic alopecia: An open-label and global photographic assessment. Dermatol Ther (Heidelb). 2020;10(6):1345–57. https://doi.org/10.1007/s13555-020-00448-x. CrossRefPubMed

28.

Sharma AN, Michelle L, Juhasz M, Ramos PM, Mesinkovska NA. Low-dose oral minoxidil as treatment for non-scarring alopecia: A systematic review. Int J Dermatol. 2020;59(8):1013–9. https://doi.org/10.1111/ijd.14933. CrossRefPubMed

29.

Vahabi-Amlashi A, Layegh P, Kiafar B, Hoseininezhad M, Abbaspour M, Khaniki S, et al. A randomized clinical trial on therapeutic effects of 0.25 mg oral minoxidil tablets on treatment of female pattern hair loss. Dermatol Ther. 2021;34(6):e15131. https://doi.org/10.1111/dth.15131.

30.

Therianou A, Vincenzi C, Tosti A, et al. How safe is prescribing oral minoxidil in patients allergic to topical minoxidil? J Am Acad Dermatol. 2022;86:429–31. https://doi.org/10.1016/j.jaad.2020.04.027. CrossRefPubMed

31.

Jerjen R, Koh WL, Sinclair R, Bhoyrul B. Low-dose oral minoxidil improves global hair density and length in children with loose anagen hair syndrome. Br J Dermatol. 2021;184:977–8. CrossRefPubMed

32.

John J, Sinclair R. Systemic minoxidil for hair disorders in pediatric patients: A safety and tolerability review. Int J Dermatol. 2023;62(2):257–9. https://doi.org/10.1111/ijd.16373. CrossRefPubMed

33.

Beach RA. Case series of oral minoxidil for androgenetic and traction alopecia: Tolerability & the five C’s of oral therapy. Dermatol Ther. 2018;31(6):e12707. https://doi.org/10.1111/dth.12707.

34.

•• Kim SR, Craiglow BG. Treatment of traction alopecia with oral minoxidil treatment of traction alopecia with oral minoxidil. JAAD Case Rep. 2022;23:112–113. https://doi.org/10.1016/j.jdcr.2022.03.023. Considering the limited data regarding the therapeutic options for tractional alopecia, this article indicted that response to oral minoxidil in this patient suggests that it may be a promising treatment for patients for tractional alopecia.

35.

Perera E, Sinclair R. Treatment of chronic telogen effluvium with oral minoxidil: A retrospective study. F1000Res. 2017;6:1650. https://doi.org/10.12688/f1000research.11775.1.

36.

Beach R, McDonald K, Barrett B, et al. Low-dose oral minoxidil for treating alopecia: A 3-year North American retrospective case series. J Am Acad Dermatol. 2021;84(3):761–3. https://doi.org/10.1016/j.jaad.2020.10.032. CrossRefPubMed

37.

Feaster B, Onamusi T, Cooley J, McMichael A. Oral minoxidil use in androgenetic alopecia and telogen effluvium. Arch Dermatol Res. 2023;315(2):201–5. https://doi.org/10.1007/s00403-022-02331-5. CrossRefPubMed

38.

Bhoyrul B, Asfour L, Lutz G, Mitchell L, Jerjen R, Sinclair R, et al. Clinicopathologic characteristics and response to treatment of persistent chemotherapy-induced alopecia in breast cancer survivors. JAMA Dermatol. 2021;157(11):1335–42. https://doi.org/10.1001/jamadermatol.2021.3676. CrossRefPubMed

39.

Martora F, Vastarella M, Fattore D, Patri A, Fabbrocini G, Cantelli M. Oral minoxidil for chemotherapy-induced alopecia. Skin Appendage Disord. 2022;8(6):508–10. https://doi.org/10.1159/000525463. CrossRefPubMedPubMedCentral

40.

Sinclair RD. Female pattern hair loss: A pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. Int J Dermatol. 2018;57(1):104–9. https://doi.org/10.1111/ijd.13838. CrossRefPubMed

41.

Kim SR, Craiglow BG. Treatment of traction alopecia with oral minoxidil. JAAD Case Rep. 2022;23:112–3. https://doi.org/10.1016/j.jdcr.2022.03.023. CrossRefPubMedPubMedCentral

42.

Mostafa DH, Samadi A, Niknam S, Nasrollahi SA, Guishard A, Firooz A. Efficacy of cetirizine 1% versus minoxidil 5% topical solution in the treatment of male alopecia: A randomized, single-blind controlled study. J Pharm Pharm Sci. 2021;24:191–199. https://doi.org/10.18433/jpps31456

43.

Choi N, Shin S, Song SU, Sung J. Minoxidil promotes hair growth through stimulation of growth factor release from adipose-derived stem cells. Int J Mol Sci. 2018;19(3):691. https://doi.org/10.3390/ijms19030691. CrossRefPubMedPubMedCentral

44.

Knitlova J, Doubkova M, Plencner M, Vondrasek D, Eckhardt A, Ostadal M, et al. Minoxidil decreases collagen I deposition and tissue-like contraction in clubfoot-derived cells: A way to improve conservative treatment of relapsed clubfoot? Connect Tissue Res. 2021;62(5):554–69. https://doi.org/10.1080/03008207.2020.1816992. CrossRefPubMed

45.

Hummadi A, Gany S, Hadi N, et al. Evaluation of the effect of topically applied methylsulfonylmethane and their combination with minoxidil solution for improvement of hair growth in male mice. Wiad Lek. 2022;75(11 pt 2):2744–2751. https://doi.org/10.36740/WLek202211206.

46.

•• Ghassemi M, Yazdanian N, Behrangi E, Jafari M, Goodarzi A. Comparison of efficacy, safety and satisfaction of latanoprost versus minoxidil, betamethasone and in combination in patients with alopecia areata: A blinded multiple group randomized controlled trial. Dermatol Ther. 2022;35(12):e15943. https://doi.org/10.1111/dth.15943. This article concluded that topical latanoprost added to therapeutic efficacy of topical betamethason and minoxidil in treating patchy AA, suggesting it being beneficial and safe adjuvant therapy and add to efficacy of topical treatments without any adverse effects.

47.

Dubaisi S, Caruso J, Gaedigk R, Vyhlidal C, Smith P, Hines R, et al. Developmental expression of the cytosolic sulfotransferases in human liver. Drug Metab Dispos. 2019;47(6):592–600. https://doi.org/10.1124/dmd.119.086363. CrossRefPubMedPubMedCentral

48.

Dhurat R, Daruwalla S, Pai S, Kovacevic M, McCoy J, Shapiro J, et al. SULT1A1 (minoxidil sulfotransferase) enzyme booster significantly improves response to topical minoxidil for hair regrowth. J Cosmet Dermatol. 2022;21(1):343–6. https://doi.org/10.1111/jocd.14299. CrossRefPubMed

49.

Pakhomova EE, Smirnova IO. Comparative evaluation of the clinical efficacy of PRP-therapy, minoxidil, and their combination with immunohistochemical study of the dynamics of cell proliferation in the treatment of men with androgenetic alopecia. Int J Mol Sci. 2020;21(18):6516. https://doi.org/10.3390/ijms21186516. CrossRefPubMedPubMedCentral

50.

Masoud F, Alamdari H, Asnaashari S, Shokri J, Javadzadeh Y. Efficacy and safety of a novel herbal solution for the treatment of androgenetic alopecia and comparison with 5% minoxidil: A double-blind, randomized controlled trial study. Dermatol Ther. 2020;33(6): e14467. https://doi.org/10.1111/dth.14467. CrossRefPubMed

51.

Liao A, Lin K, Chuang H, Tsai C, Li Y, Wang C, et al. Low-frequency dual-frequency ultrasound-mediated microbubble cavitation for transdermal minoxidil delivery and hair growth enhancement. Sci Rep. 2020;10(1):4338. https://doi.org/10.1038/s41598-020-61328-0.

52.

Faghihi G, Nabavinejad S, Mokhtari F, Naeini F, Iraji F. Microneedling in androgenetic alopecia; comparing two different depths of microneedles. J Cosmet Dermatol. 2021;20(4):1241–7. https://doi.org/10.1111/jocd.13714. CrossRefPubMed

53.

Fujita J. Favorable effects of microneedling on long-standing androgenetic alopecia in an elderly man: A case report. J Cosmet Dermatol. 2021;20(2):588–90. https://doi.org/10.1111/jocd.13526. CrossRefPubMed

54.

Ferrara F, Kakizaki P, De Brito F, Contin L, Machado C, Donati A, et al. Efficacy of minoxidil combined with photobiomodulation for the treatment of male androgenetic alopecia. A double-blind half-head controlled trial. Lasers Surg Med. 2021;53(9):1201–1207. https://doi.org/10.1002/lsm.23411.

55.

Villani A, Fabbrocini G, Ocampo-Candiani J, Ruggiero A, Ocampo-Garza S. Review of oral minoxidil as treatment of hair disorders: In search of the perfect dose. J Eur Acad Dermatol Venereol. 2021;35(7):1485–92. https://doi.org/10.1111/jdv.17216. CrossRefPubMed

56.

Vañó-Galván S, Pirmez R, Hermosa-Gelbard A, Moreno-Arrones Ó, Saceda-Corralo D, Rodrigues-Barata R, et al. Safety of low-dose oral minoxidil for hair loss: A multicenter study of 1404 patients. J Am Acad Dermatol. 2021;84(6):1644–51. https://doi.org/10.1016/j.jaad.2021.02.054. CrossRefPubMed

57.

Cavallini G. Minoxidil versus nitroglycerine: A prospective, double-blind, controlled trial in transcutaneous therapy for organic impotence. Int J Impot Res. 1994;6(4):205–12. PubMed

58.

Cecchi M, Sepich CA, Felipetto R, Vigano L, Pagni G, Minervini R, et al. Vacuum constriction device and topical minoxidil for management of impotence. Arch Esp Urol. 1995;48(10):1058–9. PubMed

59.

Perez-Mora P, Velasco C, Bermüdez F, et al. Oral finasteride presents with sexual-unrelated withdrawal in long-term treated androgenic alopecia in men. Skinmed. 2015;13(3):179–83.

60.

•• Tavakoli M, Faraji M, Sam S, Ghasempour A, Rezaei M, Langarizadeh M, et al. Erectile dysfunction from mechanisms to medicines with a focus on the application of topical minoxidil. Sex Med Rev. 2023;qead001. https://doi.org/10.1093/sxmrev/qead001. This article is based on the study of topical minoxidil’s effectiveness in treating erectile dysfunction (ED). Although evidence to confirm the therapeutic properties of minoxidil in ED is limited, combination therapy and the use of modern formulations of minoxidil are promising options for treating ED in the future.

Title: Oral Minoxidil Therapy in Hair Loss: Where Do We Stand?
Author: Ghadah Alhetheli
Publication date: 20-11-2023
Publisher: Springer US
Keywords: Minoxidil
Alopecia
Hypertrichosis
Published in: Current Dermatology Reports
Electronic ISSN: 2162-4933
DOI: https://doi.org/10.1007/s13671-023-00414-8

Keynote Webinar | Spotlight on Diet and Diabetes

Springer Medicine

Oral Minoxidil Therapy in Hair Loss: Where Do We Stand?

Abstract

Purpose of Review

Recent Findings

Summary

Keynote Webinar | Spotlight on Diet and Diabetes

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content