Combating “dread shed”: The impact of overlapping topical and oral minoxidil on temporary hair shedding during oral minoxidil initiation

Abstract

BackgroundLow dose oral minoxidil (LDOM) is a preferred treatment for alopecia due to ease of use and efficacy. While LDOM is typically well tolerated, patients may experience a temporary increase in hair shedding starting treatment, colloquially regarded as “dread shed”. One proposed method to combat this is to overlap therapies by maintaining use of topical minoxidil when initiating LDOM. ObjectiveTo evaluate the impact of maintaining topical minoxidil when initiating LDOM on “dread shed”. MethodsWe performed a retrospective chart review of patients seen at NYU Langone Health Dermatology from 1/1/08 - 8/28/23 prescribed LDOM. Results115 patients met inclusion criteria, of whom 37 maintained use of topical minoxidil when initiating LDOM. 6 patients experienced “dread shed” when initiating LDOM, 2 of whom overlapped therapies. We did not find that overlapping therapies had a significant impact on decreasing rates of “dread shed”. LimitationsLimitations include retrospective design, sample size, and subjective patient-reported assessment of hair shedding. Conclusions5.2% of patients experienced dread shed, which is lower than previously reported in literature. Maintaining topical minoxidil during LDOM initiation does not significantly impact “dread shed”. This remains a significant side effect deserving of further research.