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Minoxidil 1 mg Orally versus Minoxidil 5% Solution Topically for the Treatment of
Female Pattern Hair Loss: A Randomized Clinical Trial
Paulo Müller Ramos, Rodney D. Sinclair, Michal Kasprzak, Hélio Amante Miot
PII: S0190-9622(19)32666-0
DOI: https://doi.org/10.1016/j.jaad.2019.08.060
Reference: YMJD 13782
To appear in: Journal of the American Academy of Dermatology
Received Date: 10 February 2019
Revised Date: 10 August 2019
Accepted Date: 22 August 2019
Please cite this article as: Ramos PM, Sinclair RD, Kasprzak M, Miot HA, Minoxidil 1 mg Orally
versus Minoxidil 5% Solution Topically for the Treatment of Female Pattern Hair Loss: A Randomized
Clinical Trial, Journal of the American Academy of Dermatology (2019), doi: https://doi.org/10.1016/
j.jaad.2019.08.060.
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© 2019 Published by Elsevier on behalf of the American Academy of Dermatology, Inc.
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Title page:
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Article Type: Research Letter
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Title: Minoxidil 1 mg Orally versus Minoxidil 5% Solution Topically for the
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Treatment of Female Pattern Hair Loss: A Randomized Clinical Trial
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Running head: Oral versus topical minoxidil for female pattern hair loss
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Word Count: 520 / Tables: 2 / Figures: 0 / References: 5
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Authors:
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Paulo Müller Ramos
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Dermatologist, M.D.; MSc, Departamento de Dermatologia e Radioterapia,
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UNESP, Botucatu, SP, Brazil.
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dermato.paulo@gmail.com
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Rodney D. Sinclair
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Dermatologist, MBBS, M.D.; FACD, Professor of Dermatology, Department of
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Medicine, University of Melbourne, Parkville. VIC, Australia
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Sinclair Dermatology, Melbourne, VIC, Australia
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Rodney.Sinclair@sinclairdermatology.com.au
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Michal Kasprzak
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TrichoLAB, Bad Birmbach, Germany
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michal.kasprzak@tricholab.com
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Hélio Amante Miot
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Dermatologist, M.D.; PhD, Associate Professor, Departamento de Dermatologia
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e Radioterapia, UNESP, Botucatu, SP, Brazil.
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heliomiot@gmail.com
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Correspondence:
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Paulo Müller Ramos
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Av; Prof. Mário Rubens Guimarães Montenegro, sn
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UNESP – Campus Botucatu
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18618687 – Botucatu - SP
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Email: dermato.paulo@gmail.com
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Funding source: São Paulo Dermatology Support Fund – Sebastião Sampaio
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(FUNADERSP).
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IRB approval: This project was approved by the UNESP IRB.
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TRIAL REGISTRATION ReBEC - ensaiosclinicos.gov.br – Identifier: RBR-
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6c26hx
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Conflict of interest: Rodney Sinclair is director and stockholder of Samson
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Medical PTY LTD that holds patents on the use of oral minoxidil to treat hair
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loss. The other authors have no conflict of interest to declare.
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Reprint request: Not necessary
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Acknowledgements: None
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Abstract: Not necessary for letters
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Keywords: Female pattern hair loss, androgenetic alopecia, minoxidil, oral,
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topical, hypertrichosis, treatment
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60
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3
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Abbreviation list
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TM – Topical minoxidil;
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FDA – Food and Drug Administration;
66
FPHL – Female pattern hair loss;
67
OM – Oral minoxidil;
68
UNESP – Universidade Estadual Paulista;
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WAA-QoL – Women's Androgenetic Alopecia Quality of Life Questionnaire;
70
CI 95% – confidence interval;
71
bpm – beats per minute (heart rate)
72
73
4
Topical minoxidil (TM) is the only FDA-approved drug for treatment of female
74
pattern hair loss (FPHL). Premature discontinuation of treatment commonly
75
occurs due to lack of perceived efficacy, adverse effects or altered hair texture.
76
Low-dose oral minoxidil (OM) has been reported as effective for FPHL (0.25–
77
1.25mg/day).
1,2
To date, no study has compared the relative efficacy of OM
78
and TM in the treatment of FPHL.
79
We performed a 24-week, randomized, open, comparative study of 1mg OM
80
versus TM 5% solution for the treatment of FPHL, at a dermatology clinic
81
(UNESP-Botucatu, São Paulo, Brazil).
82
Women between 18 and 65 years old with FPHL (Sinclair’s Stage II-IV) were
83
randomly assigned to receive 1mg OM or TM 5% solution (1ml), once daily, for
84
24 weeks.
85
The primary endpoint was the change in total hair density in a target area
86
(parietal) from the baseline to week 24. Blinded analysis of the trichoscopic
87
images was performed using TrichoLAB Hair-to-Hair Matching technology (Bad
88
Birmbach, Germany). Secondary outcomes were: change in terminal hair
89
density; global photographic evaluation (three board-certified dermatologists);
90
quality-of-life evaluation using the Women's Androgenetic Alopecia Quality of
91
Life Questionnaire (WAA-QoL); and Sinclair’s hair-shedding score (six-point
92
scale).
3
93
Outcomes were compared according to time and to the groups (over time) by
94
linear mixed-effects models. Intention to treat analysis was performed. The
95
sample size was calculated to detect a difference greater than 20% in hair
96
density between the groups (alpha: 0.01, power: 0.9).
97
5
Fifty-two participants were enrolled (table 1). Baseline characteristics were
98
similar between the groups (p0.05). Fifty participants completed the trial.
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Dropouts were not related to treatment side effects. The main outcomes are
100
presented in table 2. After 24 weeks of treatment the total hair density increased
101
by 12% (CI 95% 8.0-16.1%) in women taking OM and 7.2% (CI 95% 1.5-12.9%)
102
in women applying TM, with no difference between them (p=0.10).
103
Adverse events are shown in table 2. Scalp pruritus affected 19% of
104
participants in the TM group. Pretibial edema occurred in 4% participants in the
105
OM group. Hypertrichosis was more commonly with OM: 27% versus 4%,
106
although it was mild and well tolerated. Three participants did not take any
107
action to reduce the hair and five managed it with waxing. There was no
108
difference between the groups regarding the variation of mean blood pressure
109
over time. The mean heart rate at rest increased 6.5% in the OM group without
110
tachycardia; there was no change in the TM group. No hypotension-related
111
events occurred. No adverse events in OM group required cessation of
112
medication.
113
Our results reveal that low dose OM provides improvement of FPHL that does
114
not differ from TM 5% solution, with a safe profile and well tolerated adverse
115
effects.
116
The performance of OM in hair-shedding score was superior to TM, reinforcing
117
the favorable results reported on telogen effluvium.
4
The increase in total hair
118
density lied within the TM CI95%, however if the outcomes are taken together,
119
they suggest a trend towards a greater improvement in the OM group.
120
Confirmation of this would require larger and longer studies.
121
6
In conclusion, OM can be considered an option for FPHL patients with poor
122
compliance and/or intolerability of TM.
2,4,5
123
124
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REFERENCES 125
1. Sinclair RD. Female pattern hair loss: a pilot study investigating combination 126
therapy with low-dose oral minoxidil and spironolactone. Int J Dermatol 2018;57:104-9. 127
2. Beach RA. Case series of oral minoxidil for androgenetic and traction alopecia: 128
Tolerability & the five C's of oral therapy. Dermatol Ther 2018:e12707. 129
3. Sinclair R. Hair shedding in women: how much is too much? Br J Dermatol 130
2015;173:846-8. 131
4. Perera E, Sinclair R. Treatment of chronic telogen effluvium with oral minoxidil: 132
A retrospective study. F1000Res 2017;6:1650. 133
5. Jimenez-Cauhe J, Saceda-Corralo D, Rodrigues-Barata R, et al. Effectiveness 134
and safety of low-dose oral minoxidil in male androgenetic alopecia. J Am Acad 135
Dermatol 2019: 81(2):648-9. 136
137
138
139
140
141
142
143
144
145
146
8
147
Table 1. Main clinical and demographic data from participants.
148
Oral Minoxidil
1 mg
Topical Minoxidil
5%
N
26
26
#
40.6 (12.0)
47.3 (11.8)
BMI (kg/m
2
)
##
26.3 (23.4
-
30.7)
23.5 (22.5
-
29.4)
Skin phototype
-
n (%)
II
7 (27)
7 (27)
III
13 (50)
11 (42)
IV
-
V
6 (23)
8 (31)
Race
-
n (%)
European
21 (81)
19 (73)
African
-
American
4 (15)
4 (15)
Amerindian
-
(
-
)
2 (8)
Asian
1 (4)
1 (4)
Baseline
Sinclair scale
-
n (%)
II
-
Mild
15 (58)
17 (65)
III
-
Moderate
10 (38)
8 (31)
IV
-
Severe
1 (4)
1 (4)
Baseline density
per mm
2
Total hair
164.6 (48.1)
163.2 (46.0)
Terminal hair
106.5 (34.2)
113.3 (41.1)
Hair shedding score
##
5 (3
-
5)
4
(3
-
5)
WAA
-
QoL
##
68 (51
-
80)
60 (28
-
77)
#
mean (sd);
##
median (p25-p75);
149
BMI: body mass index.
150
WAA-QoL: Women's Androgenetic Alopecia Quality of Life Questionnaire.
151
152
153
9
Table 2. Main results and adverse effects of the comparative effectiveness of oral minoxidil 1mg versus topical 5% minoxidil
solution for twenty-four weeks in the treatment of FPHL (n=52).
Oral Minoxidil
1
mg
Topical Minoxidil
5%
p-value (time*group)
T0
T24
p
-
value*
T0
T24
p
-
value*
Hair density
#
per c
m
2
Total hair
164.6 (48.1)
184.7 (57.1)
<0.01
163.2 (46.0)
176.3 (61.5)
<0.01
0.09
Terminal hair
106.5 (34.2)
112.6 (36.4)
0.03
113.3 (41.1)
116.8 (44.9)
0.09
0.17
Global photograph
##
0.16
S
lightly impaired
-
1 (4)
-
-
2 (8)
-
No change
-
7 (27)
-
-
12 (46)
-
Slightly improved
-
16 (62)
-
-
11 (42)
-
Greatly improved
-
2 (8)
1 (4)
Hair sh
e
dding score
###
5 (3
-
5)
3 (2
-
3)
<
0.01
4 (3
-
5)
4 (3
-
5)
0.20
<0.01
WAA
-
QoL
###
68 (51
-
80)
15 (6
-
36)
<0.01
60 (28
-
77)
25 (11
-
41)
<0.01
0.09
Adverse effects
Edema of the limbs
##
-
1 (4)
-
0 (
-
)
0.99
Hyperthrichosis
##
-
7 (27)
-
1 (4)
0.02
Heart rate (bpm)
#
72 (8)
77 (8)
<
0.01
70 (9)
70 (8)
0.83
<0.01
MAP (mmHg)
#
93 (9)
91 (8)
0.23
89 (11)
89 (11)
0.97
0.51
Scalp pruritus
##
-
0 (
-
)
-
5 (19)
0.0
2
* T0 vs. T24 ;
#
mean (sd);
##
n (%);
###
median (p25-p75);
WAA-QoL: Women's Androgenetic Alopecia Quality of Life Questionnaire; MAP: Mean Arterial Pressure.
10
... Ramos et al., [10] compared the efficacy of 1 mg daily OM to topical 5% solution daily and found OM to be as effective as the topical solution. This author also indicated that a lower follicular sulfotransferase activity threshold is needed for bio-activation of OM compared to topical minoxidil. ...
... This author also indicated that a lower follicular sulfotransferase activity threshold is needed for bio-activation of OM compared to topical minoxidil. [10] Common barriers for the use of topical minoxidil in male and female-patterned hair loss (FPHL) include the development of pruritus, contact dermatitis, change in hair texture, and localized hypertrichosis. [2,3] Aside from tolerability, there are several practical advantages of OM over its topical formulation: It's more convenient to swallow minoxidil than to apply it topically. ...
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Recent studies have shown that low-dose oral minoxidil (OM) can be a safe and effective treatment of numerous hair disorders including male-patterned hair loss (MPHL) and female-patterned hair loss (FPHL). There are several practical advantages of OM over its topical formulation: enhanced cosmesis, cost-savings, and the possibility of co-therapy with other topical formulations or topicals used for camouflage. This treatment may be particularly helpful for patients who are unable to tolerate topical minoxidil or other systemic treatments. Doses ranging from 0.25 to 1.25 mg daily are usually used for FPHL and doses ranging from 2.5 to 5 mg/day for MPHL. The low side-effect profile of low-dose OM allows for long-term adherence to the medication and favorable clinical response, resulting in stabilization and improvement of hair loss. More studies are needed to test the efficacy of OM in other types of alopecia as well as additional comparative studies assessing OM to other commonly used medications.
... The effective and safe treatments of FPHL remain limited. So far, topical minoxidil (MX) is the only Food and Drug Administration (FDA)-approved drug for FPHL (6). However, only approximately 40% of patients showed a significant improvement after 3 to 6 months of MX application (7). ...
... This is consistent with a previous systematic review and meta-analysis of randomized trials, which proved the efficacy and safety of topical MX in the treatment of FPHL (15). Previous studies showed that only 46-67.7% of FPHL patients treated with topical MX could get improvement (6,16). Likewise, our study showed that the effective rate of the topical MX alone group was only 55.27% at week 24, lower than 86.49% in MX + SPT group and 95.00% in MX + MN group. ...
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Background The efficacy of topical minoxidil (MX) alone on female pattern hair loss (FPHL) is limited. Combination therapy based on topical MX is currently expected to provide better outcomes. Objectives This study aimed to assess whether the combined therapies including MX plus oral spironolactone (SPT) and MX plus microneedling (MN) have advantages in efficacy and safety over topical MX alone on mild-to-moderate FPHL with normal hormone levels in the blood and regular menstrual cycle. Methods A prospective, single-center, parallel-group, evaluator blinded, randomized trial including 120 non-menopause women with proven FPHL (Sinclair class II-III) was performed in China. Patients were randomly assigned to three groups, namely, the MX group (5% topical MX alone, once daily), the MX + SPT group (MX plus SPT 80–100 mg daily), and the MX+MN group (MX plus MN every 2 weeks, 12 sessions). The change from the baseline to week 24 was assessed in hair growth (hair density and diameter under dermoscope), scalp tissue structure (epidermal thickness, dermis thickness, and average hair follicle diameter under ultrasound biomicroscopy), physician's global assessment (using a 7-point global-assessment scale and Sinclair's stage change), patient evaluation (Women's Androgenetic Alopecia Quality of Life Questionnaire and Sinclair's hair-shedding score) and side effects. Results In total, 115 participants completed the trial. At week 24, the hair density increased most in MX + MN group and increased least in MX group ( p < 0.001 for MX + MN group vs. MX + SPT group; p = 0.009 for MX + SPT group vs. MX group). The hair shaft diameter significantly increased in all groups ( p < 0.001, respectively), but there were no significant differences among the three groups ( p = 0.905). The epidermal thickness and average hair follicle diameter only increased in MX + MN group. Dermis thickness increased in all groups, but there were no significant differences among the three groups. Both physician's and patient assessments showed improvement in all three groups. Scalp pruritus was the most common side effect. The MX + SPT group had the most reported adverse effects. Limitations The main limitations of this study are the relatively small sample size, the exclusion of severe FPHL patients, and the potential bias from unblinded treatments among the 3 groups. Conclusion Topical MX combined with MN is a better choice than either MX plus oral SPT or MX alone for the treatment of mild-to-moderate FPHL patients.
... Studies that were eligible for quantitative analyses were trials that were published in the English language and investigated the efficacy of monotherapy with oral minoxidil in persons diagnosed with AGA. The logistics of our quantitative analyses was determined by the data that were gathered after the systematic search; all analyses were done with RStudio [10], and alpha (i.e., cutoff for statistical significance) was set at 5%. Figure 1 delineates our search process; we identified six studies that were eligible for quantitative analyses [11][12][13][14][15][16] (Fig. 1). For our four endpoints of interest, Table 1 Records indicates which of the six studies the respective endpoints used data from; across the eligible studies, the dosages ranged from 0.25 to 5 mg daily. ...
... Table 1. Trials -on AGA -used for data analyses of the four endpoints, namely 6-month change in hair diameter, risk of hypertrichosis, and hair density (terminal and total) Studies used for quantitative analyses of the respective outcomes Outcome (measured at baseline and after 6 months) hair diameter total hair density terminal hair density occurrence of hypertrichosis Jha et al. [15] ✓ Panchaprateep and Lueangarun [11] ✓ ✓ ✓ ✓ Pirmez and Salas-Callo [12] ✓ ✓ ✓ Ramos et al. [14] ✓ ✓ ✓ Vahabi-Amlashi et al. [13] ✓ ✓ Vastarella et al. [16] ✓ ✓ ✓ ✓ The point estimate (i.e., β) corresponds to an estimate of the change in the outcome that results from a unit change in oral minoxidil dosage across persons with AGA; estimation accounts for sex difference. For example, the "β = 47.10" ...
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Background: Recently, low-dose oral minoxidil (LDOM) has entered the landscape of therapies for androgenetic alopecia (AGA). We determined whether using LDOM is associated with improving AGA in a dose-dependent manner; secondarily, we examined whether a dose-dependent association also exists for safety. Methods: Systematic searches were conducted in PubMed and Scopus to identify studies that would be eligible for our quantitative analyses; the logistics of our analyses was determined by the data we gathered. Results: Six studies were eligible for quantitative analyses; we conducted meta-regressions. We found that, for persons with AGA, increasing the dosage of LDOM by 1 mg/day was - after six months - significantly associated with an expected sex-adjusted increase in hair diameter (mean difference = 1.4 μm, p = 0.01), total hair density (mean difference = 47.1 hairs/cm2, p = 0.007), terminal hair density (mean difference = 9.1 hairs/cm2, p = 0.001), risk of hypertrichosis (mean difference = 17.9%, p = 0.006), and cardiovascular adverse events (mean difference = 4.8%, p = 0.004). Conclusions: Our study produced new evidence as our work is the first to show a positive dose-dependent association between the use of LDOM and change in hair diameter, hair density, risk of hypertrichosis, and cardiovascular adverse events for persons with AGA. Future randomized trials could produce causal evidence that would corroborate these dose-dependent associations.
... Patients with high systolic blood pressure (SBP) ([130 mmHg) recorded within 2 hours before LDOM administration showed a higher reduction within 2 hours after intake, compared with the patients with normal SBP (À11.7 vs À4.8 mmHg, respectively) (P ¼.14). One patient reported lightheadedness 1 hour after LDOM intake, showing an important reduction in BP ( [3][4][5] Only one study evaluated patients after the admistration of first dose of 5-mg minoxidil, and found a nonsignificant variation in BP and HR, similarly to our results. 3 In addition, we found that patients with high SBP ([130 mmHg) showed a higher reduction than those with normal SBP, which is consistent with the Variation 4h before-4h after intake À0.7 (6.2) À4.3 (8.8) .35 ...
... They found that LDOM improved hair-shedding score when compared to TM in a statistically significant way. 6 When comparing efficacy of TM to LDOM, there are no RCTs in MPHL and there is just one RCT with a small sample in FPHL. More RCTs need to be done to improve our knowledge in the efficacy of both forms. ...
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Abstract Androgenetic alopecia is one of the most common dermatologic disorders in the daily clinical practice of dermatologists. Despite it is such a common entity, few medications are FDA‐approved for its treatment. Due to this situation dermatologists are often reluctant to try off‐label therapies. This guide's purpose is to review the current available therapies for androgenetic alopecia including those off‐label, and to propose treatment algorithms according to the published scientific research.
... Ramos et al, compared 1 mg OM versus 5% TM in 52 patients with FPHL in a randomized open comparative study with an endpoint of change in total hair density in a parietal area from baseline to 6 months and he observed that both OM and TM are equally effective in terms of efficacy and safety (12% women taking OM showed increased total hair density and 7% women applying 5% TM). [16] Beach et al, in their study of 18 patients with AGA and traction alopecia with a daily dose of OM 1.25 mg, observed decreased hair shedding in 33% and increased scalp hair in 28% of patients at 6 months follow-up. [6] Jha et al. studied a dose of 1.25 mg in male AGA with improvement in hair shedding and concluded that a higher dosage may be needed in patients without any response in 6 months of treatment. ...
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In the 1970s, the American pharmaceutical company Upjohn & Pharmacia developed the antihypertensive drug Minoxidil and launched it under the brand name Loniten®, in the form of 2.5 mg and 10 mg tablets. Minoxidil is a pyrimidine derivative (2,4 diamino-6-piperidinopyrimidine-3-oxide), has a molecular weight of 209.25, and its action is focused on vascular adenosine triphosphate-sensitive potassium channels (KATP). Intravenous and oral Minoxidil will potently reduce both systolic and diastolic pressure, as well as the peripheral resistance of arteries, but not veins [1]. Minoxidil is very potent, and its antihypertensive use seemed, in the beginning, particularly promising for the management of severe, refractory hypertension [2].
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Background: Androgenetic alopecia (AGA) is the most common cause of hair loss, often challenging to treat. While oral finasteride (1 mg/d) is an FDA-approved treatment for male AGA, oral minoxidil and oral dutasteride are not approved yet. However, clinicians have been increasingly using these two drugs off-label for hair loss. Recently, Japan and South Korea have approved oral dutasteride (0.5 mg/d) for male AGA. Efficacy and safety: A probable efficacy ranking, in decreasing order, is - dutasteride 0.5 mg/d, finasteride 5 mg/d, minoxidil 5 mg/d, finasteride 1 mg/d, followed by minoxidil 0.25 mg/d. Oral minoxidil predominantly causes hypertrichosis and cardiovascular system (CVS) symptoms/signs in a dose-dependent manner, whereas oral finasteride and dutasteride are associated with sexual dysfunction and neuropsychiatric side effects. Pharmacokinetics and pharmacodynamics: The average plasma half-lives of minoxidil, finasteride, and dutasteride are ∼4 h, ∼4.5 h, and ∼5 weeks, respectively. Minoxidil acts through multiple pathways to promote hair growth. It has been shown as a vasodilator, an anti-inflammatory agent, a Wnt/β-catenin signaling inducer, and an antiandrogen. Finasteride inhibits 5α-reductase (5AR) type II isoenzyme, while dutasteride inhibits both type I and type II. Thus, dutasteride suppresses DHT levels more than finasteride in the serum and scalp.
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Background: Minoxidil and spironolactone are oral antihypertensives known to stimulate hair growth. Objective: To report on a case series of women with pattern hair loss (PHL) treated with once daily minoxidil 0.25 mg and spironolactone 25 mg. Methods: Women newly diagnosed with a Sinclair stage 2-5 PHL were scored for hair shedding and hair density before and after 12 months of treatment with oral minoxidil 0.25 mg and spironolactone 25 mg. Results: A total of 100 women were included in this observational pilot study. Mean age was 48.44 years (range 18-80). Mean hair loss severity at baseline was Sinclair 2.79 (range 2-5). Mean hair shedding score at baseline was 4.82. Mean duration of diagnosis was 6.5 years (range 0.5-30). Mean reduction in hair loss severity score was 0.85 at 6 months and 1.3 at 12 months. Mean reduction in hair shedding score was 2.3 at 6 months and 2.6 at 12 months. Mean change in blood pressure was -4.52 mmHg systolic and -6.48 mmHg diastolic. Side effects were seen in eight women but were generally mild. No patients developed hyperkalemia or any other blood test abnormality. Six of these women continued treatment, and two women who developed urticaria discontinued treatment. Limitations: Prospective, uncontrolled, open-label observational study. Discussion: Once daily capsules containing minoxidil 0.25 mg and spironolactone 25 mg appear to be safe and effective in the treatment of FPHL. Placebo-controlled studies to investigate this further are warranted.
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Background: Chronic telogen effluvium (CTE) may be primary or secondary to various causes, including drug reaction, nutritional deficiency and female pattern hair loss (FPHL). Oral minoxidil stimulates hair growth, and topical minoxidil is used in the treatment of FPHL and male androgenetic alopecia. minoxidil has not been used to treat CTE. This study aimed to assess the treatment of CTE with once daily oral minoxidil. Methods: Women with a diagnosis of CTE based on >6 month history of increased telogen hair shedding, no visible mid frontal scalp hair loss (Sinclair stage 1) and no hair follicle miniaturization on scalp biopsy were treated with once daily oral minoxidil. Hair shedding scores (HSS) at baseline, 6 and 12 months were analysed using the Wilcoxon rank sum test for pair-wise comparisons. Results: Thirty-six women were treated with oral minoxidil (range, 0.25-2.5 mg) daily for 6 months. Mean age was 46.9 years (range 20-83), HSS at baseline was 5.64, and duration of diagnosis was 6.55 years (range 1-27). There was a reduction in mean HSS scores from baseline to 6 months of 1.7 (p<0.001) and baseline to 12 months of 2.58 (p<0.001). Five women who described trichodynia at baseline, noted improvement or resolution within 3 months. Mean change in blood pressure was minus 0.5 mmHg systolic and plus 2.1 mmHg diastolic. Two patients developed transient postural dizziness that resolved with continued treatment. One patient developed ankle oedema. Thirteen women developed facial hypertrichosis. For 6 patients this was mild and did not require treatment; 4 had waxing of their upper lip or forehead; 3 had laser hair removal. No patients developed any haematological abnormality. All 36 women completed 12 months of treatment. Conclusions: Once daily oral minoxidil appears to reduce hair shedding in CTE. Placebo controlled studies are recommended to further assess this response.
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Human hair growth is cyclical but asynchronous. Women normally shed 50-150 hairs over a 24 hour period [1]. Most shedding goes unnoticed. Women who complain of excessive hair shedding, especially after washing their hair may have either an increase in the actual amount of hair falling or an increased awareness of their hair fall. Changes in actual amount of hair fall occur in anagen effluvium, acute and chronic telogen effluvium, alopecia areata, cicatricial alopecia and female pattern hair loss (FPHL) [1]. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Tolerability & the five C's of oral therapy
Tolerability & the five C's of oral therapy. Dermatol Ther 2018:e12707. 129 3.
Treatment of chronic telogen effluvium with oral minoxidil: WAA-QoL: Women's Androgenetic Alopecia Quality of Life Questionnaire
  • E Perera
  • R Sinclair
Perera E, Sinclair R. Treatment of chronic telogen effluvium with oral minoxidil: WAA-QoL: Women's Androgenetic Alopecia Quality of Life Questionnaire.