Low-Dose Oral Minoxidil for Hair Growth

Low-dose oral minoxidil (LDOM) is getting traction amongst dermatologists as a substitute for treating hair loss issues.

Hair loss, often known as alopecia, is among the commonest beauty situations dermatologists diagnose and deal with, affecting 60% to 70% of adults worldwide and costing round 3.5 billion {dollars} yearly within the United States.¹ Moreover, hair loss in youngsters accounts for about 3% of all pediatrician visits.²

“There are many treatments available for alopecia,” says Michael H. Gold, MD, medical director of Gold Skin Care Center in Nashville, Tennessee. “The most important thing we as dermatologists must do is accurately diagnose the cause of the alopecia. Is it androgenetic alopecia or related to a medical concern or a medication that they may be on? If it is androgenetic alopecia, then we can use topical or intralesional steroids in some, we can use platelet-rich plasma in some, and we can use nutraceuticals such as Nutrafol or Viviscal, and then when needed, hair transplants.”

Although topical minoxidil has been used as an efficient therapy for varied hair issues for many years, most sufferers present poor adherence with the remedy typically due to price; uncomfortable side effects corresponding to rashes, itching, and irritation; and beauty issues.³

“We are transitioning to low-dose minoxidil because some of our patients do not want to use topical therapies: [1 reason given] is that it makes their hair greasy,” Gold explains.

A latest evaluation printed within the Journal of the American Academy of Dermatology suggests LDOM as a well-tolerated and efficient remedy for treating hair issues in normotensive sufferers having problem with topical options. The evaluation included research during which sufferers obtained LDOM as the first remedy, dosed between 0.25 and 5 mg/day. Patients receiving excessive dosages, ie, 5 mg/day, have been reported to expertise extra antagonistic results, together with hypertrichosis and decrease limb edema.⁴

A 3-year retrospective case collection reported elevated scalp hair development and decreased hair shedding in sufferers receiving LDOM, significantly with nonscarring alopecia.⁵

Evidence suggests that girls require decrease doses, from 0.25 to 2.5 mg/day, whereas males require from 2.5 to five mg/day for maximal efficacy.³

“It can be used as a first-line therapy—although we usually start with topical therapy or finasteride orally first. When using low-dose minoxidil, it is important to let patients know that it is off label, but several published studies have shown safety and efficacy,” says Gold. (The FDA permitted topical minoxidil 2% for the therapy of male androgenetic alopecia and feminine sample hair loss in 1988 and 1992, respectively. On the opposite, using the oral type of the drug for hair development stays off label. ⁶) “The response rates in the clinical work done vary, but many have shown > 65% success rates,” notes Gold.

Oral minoxidil was initially synthesized as an antihypertensive drug at a day by day dosage of 10 to 40 mg.⁵ It grew to become standard in treating hair loss after scientific trials coincidentally seen hirsutism and hypertrichosis amongst potential drug uncomfortable side effects, resulting in its utilization in treating hair loss issues in topical kind (Rogaine).⁷

Lately, LDOM has been studied for the therapy of varied hair issues, with probably the most studied situation being androgenetic alopecia. Other hair issues embody telogen effluvium, everlasting chemotherapy-induced alopecia, traction alopecia, alopecia areata, monilethrix, scarring alopecia, and free anagen hair syndrome.

When requested about the commonest explanation for hair loss, Gold says, “Genetics by far, but also some diseases like thyroid disease in some, and medications—which has a list a mile long.”

The use of LDOM for hair loss was initially investigated by Rodney Sinclair, MD, professor of dermatology on the University of Melbourne. He performed a pilot research and instructed using oral minoxidil (0.25 mg) at the side of spironolactone (25 mg) as a protected and efficient therapy for feminine sample hair loss.⁸

“I began investigating oral minoxidil in hair growth around 2005 and that IJD paper was the first of my teams’ publications on oral minoxidil,” Sinclair says. “The published results have been verified by multiple authors in multiple countries.”

“Oral minoxidil is already widely prescribed by dermatologists to treat hair loss worldwide. A recent publication from Spain showed more than 25% of dermatologists regularly prescribe it. We found similar numbers in Australia. Most of the hair experts in the United States now use it,” he explains.

Although dermatologists have been utilizing topical minoxidil to deal with sufferers with alopecia for a few years, the mechanism by which minoxidil stimulates hair development stays to be absolutely elucidated. However, animal research have proven that the drug stimulates hair development by shortening the telogen and prolonging the anagen part.

“Minoxidil prolongs anagen duration, thereby reducing hair shedding and increasing hair length; increases fiber diameter, thereby making hair stronger and reducing breakage; and reverses hair miniaturization, thereby increasing hair counts in balding scalp. It does this by increasing the uptake of the amino acid cysteine into the hair bulb outer root sheath. Transport of cysteine into hair cortex keratinocytes in the emerging anagen fiber is the final step in hair keratinization and the rate-limiting step in hair growth,” Sinclair says.

The utilization of oral minoxidil at its normal dosage for hair development is proscribed due to uncomfortable side effects related to its normal dosage.⁸ Although the drug is initially indicated for refractory hypertension and comes with a black field warning from the FDA for the chance of growing pericardial effusion, it exerts minimal vasodilatory results on normotensive sufferers. The mostly noticed uncomfortable side effects included pedal edema, tachycardia, and generalized hypertrichosis.^9,10

According to the American Academy of Dermatology Association, minoxidil ought to be averted in lactating girls and those that are pregnant or planning to get pregnant due to its potential teratogenic results.¹¹

Although dermatologists advocate LDOM to avert uncomfortable side effects related to topical minoxidil, the oral kind comes with its personal uncomfortable side effects. A research printed within the Journal of the American Academy of Dermatology discovered 1 mg oral minoxidil and topical minoxidil 5% resolution to be equally efficient in treating feminine sample hair loss. However, hypertrichosis was extra widespread in sufferers taking LDOM than their counterparts, which is extra troublesome for girls than males.¹²

“Hypertrichosis can occur and is dose-dependent. Interestingly, the hypertrichosis is patterned (upper lip, sideburns, forehead, forearms) rather than generalized and can be reduced by antiandrogens such as bicalutamide. That published finding was a surprise,” says Sinclair. “As there is significant tachyphylaxis with respect to the antihypertensive effects of minoxidil, I always start patients off on a low dose and review the patient every 6 to 12 weeks for dose titration,” he additional explains.

References

1. Hu XM, Li ZX, Zhang DY, et al. A scientific abstract of survival and loss of life signalling through the lifetime of hair follicle stem cells. Stem Cell Res Ther. 2021;12(1):453. doi:10.1186/s13287-021-02527-y
2. American Hair Loss Association. Children’s hair loss. Accessed September 29, 2022. https://www.americanhairloss.org/children_hair_loss/introduction.html
3. Villani A, Fabbrocini G, Ocampo-Candiani J, Ruggiero A, Ocampo-Garza SS. Review of oral minoxidil as therapy of hair issues: in quest of the proper dose. J Eur Acad Dermatol Venereol. 2021;35(7):1485-1492. doi:10.1111/jdv.17216
4. Randolph M, Tosti A. Oral minoxidil therapy for hair loss: a evaluation of efficacy and security. J Am Acad Dermatol. 2021;84(3):737-746. doi:10.1016/j.jaad.2020.06.1009
5. Beach RA, McDonald KA, Muylaert Barrett B. Low-dose oral minoxidil for treating alopecia: a 3-year North American retrospective case collection. J Am Acad Dermatol. 2021;84(3):761-763. doi:10.1016/j.jaad.2020.10.032
6. Kowe PA, Madke B, Bansod SH. Oral minoxidil in trichology: a evaluation. Indian J Drugs Dermatol. 2022;8:1-6
7. Dlova NC, Jacobs T, Singh S. Pericardial, pleural effusion and anasarca: A uncommon complication of low-dose oral minoxidil for hair loss. JAAD Case Rep. 2022;28:94-96. doi:10.1016/j.jdcr.2022.07.044
8. Sinclair RD. Female sample hair loss: a pilot research investigating mixture remedy with low-dose oral minoxidil and spironolactone. Int J Dermatol. 2018;57(1):104-109. doi:10.1111/ijd.13838
9. Jerjen R, Koh WL, Sinclair R, Bhoyrul B. Low-dose oral minoxidil improves world hair density and size in youngsters with free anagen hair syndrome. Br J Dermatol. 2021;184(5):977-978. doi:10.1111/bjd.19756
10. Heymann WR. Coming full circle (nearly): Low dose oral minoxidil for alopecia. American Academy of Dermatology Association. January 5, 2022. Accessed September 29, 2022. https://www.aad.org/dw/dw-insights-and-inquiries/archive/2022/low-dose-oral-minoxidil-alopecia
11. Thinning hair and hair loss: might or not it’s feminine sample hair loss? American Academy of Dermatology Association. Updated October 3, 2022. Accessed October 4, 2022. https://www.aad.org/public/diseases/hair-loss/types/female-pattern
12. Ramos PM, Sinclair RD, Kasprzak M, Miot HA. Minoxidil 1 mg oral versus minoxidil 5% topical resolution for the therapy of female-pattern hair loss: a randomized scientific trial. J Am Acad Dermatol. 2020;82(1):252-253. doi:10.1016/j.jaad.2019.08.060