Low-dose oral minoxidil for treatment of androgenetic alopecia and telogen effluvium in a pediatric population: A descriptive study

Abstract

To the Editor: Topical minoxidil has been described for the treatment of children’s hair disorders.1Lemes L.R. Melo D.F. de Oliveira D.S. de La-Rocque M. Zompero C. Ramos P.M. Topical and oral minoxidil for hair disorders in pediatric patients: what do we know so far?.Dermatol Ther. 2020; 33e13950Crossref PubMed Scopus (9) Google Scholar,2Griggs J. Burroway B. Tosti A. Pediatric androgenetic alopecia: a review.J Am Acad Dermatol. 2021; 85: 1267-1273Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Despite its safety, local irritant dermatitis and difficulties in its application may limit adherence.1Lemes L.R. Melo D.F. de Oliveira D.S. de La-Rocque M. Zompero C. Ramos P.M. Topical and oral minoxidil for hair disorders in pediatric patients: what do we know so far?.Dermatol Ther. 2020; 33e13950Crossref PubMed Scopus (9) Google Scholar,2Griggs J. Burroway B. Tosti A. Pediatric androgenetic alopecia: a review.J Am Acad Dermatol. 2021; 85: 1267-1273Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar The objective of our study is to describe the use of low-dose oral minoxidil (LDOM) for the treatment of hair disorders in a pediatric population in order to broaden therapeutic options in this age group. We retrospectively reviewed medical records of patients <18 years who attended a trichology-specialized clinic in Spain for a period of 2 years (between March 2019 and March 2021). From among these patients, we selected those patients who were diagnosed with androgenetic alopecia or telogen effluvium and had received treatment with LDOM. The epidemiologic and clinical features of the selected patients were collected. In total, 45 patients with a mean age of 16 years (range, 10-17 years) were included in our study (Table I). All the patients weighed >40 kg. Diagnosis was determined upon clinical and trichoscopic findings. Thirty-nine patients (87%) were diagnosed with androgenetic alopecia and 6 patients (13%) were diagnosed with telogen effluvium. LDOM was used in monotherapy in 14 children (31%), combined with other topical treatments (topical minoxidil or topical finasteride) in 8 patients (18%), and used with other oral treatments (finasteride, dutasteride, bicalutamide or spironolactone) in 23 patients (51%). Minoxidil was prescribed and compounded at a mean daily dose of 1.24 mg in 23 patients, with lower doses in girls (mean dosage 0.63 mg) compared to boys (mean dosage 2.35 mg). Although dose election was personalized, we usually started with 0.5 mg daily, doubling it in each subsequent visit if more improvement was needed.Table IEpidemiologic and clinical data of patients <18 years of age who received treatment with low-dose oral minoxidilTotalBoysGirlsTotal patientsn = 45n = 16n = 29Age,∗In the sections of age, minoxidil daily dose, and treatment duration, numbers correspond to the unit detailed in each case, with the numbers in parentheses presenting the range. y (range)16 (10-17)16.3 (14-17)15.9 (10-17) Diagnosis†The remaining data are reported as number (percentage) of patients presenting each characteristic.AGA39 (86.7)16 (100)23 (79.3)TE6 (13.3)06 (20.7)Minoxidil mean daily dose∗In the sections of age, minoxidil daily dose, and treatment duration, numbers correspond to the unit detailed in each case, with the numbers in parentheses presenting the range., mg/d (range)1.24 (0.14-5)2.35 (0.5-5)0.63 (0.14-2.5) Treatment plan†The remaining data are reported as number (percentage) of patients presenting each characteristic.Monotherapy14 (31.1)3 (18.8)11 (37.9)Combined with oral treatments23 (51.1)10 (62.5)13 (44.8)Combined with topical treatments8 (17.8)3 (18.8)5 (17.2)Patients with recorded follow upn = 40n = 14n = 26Treatment duration,∗In the sections of age, minoxidil daily dose, and treatment duration, numbers correspond to the unit detailed in each case, with the numbers in parentheses presenting the range. mo (range)9.8 (3-24)9.1 (3-22)10.1 (3-24)Effectiveness†The remaining data are reported as number (percentage) of patients presenting each characteristic. In AGAStabilization8 (22.9)3 (21.4)5 (23.8)Improvement27 (77.1)11 (78.6)16 (76.2) In TEStabilization000Improvement5 (100)05 (100)Adverse effects†The remaining data are reported as number (percentage) of patients presenting each characteristic. Total10 (25)1 (7.1)9 (34.6) Mild hypertrichosis7 (17.6)07 (26.9) Hypotension1 (2.5)01 (3.8) Shedding2 (5)1 (7.1)1 (3.8)AGA, Androgenetic alopecia; d, day; mo, months; TE, telogen effluvium; y, year.∗ In the sections of age, minoxidil daily dose, and treatment duration, numbers correspond to the unit detailed in each case, with the numbers in parentheses presenting the range.† The remaining data are reported as number (percentage) of patients presenting each characteristic. Open table in a new tab AGA, Androgenetic alopecia; d, day; mo, months; TE, telogen effluvium; y, year. Forty patients completed at least 1 follow-up visit to assess LDOM’s effectiveness and safety. At the time of analysis, treatment duration was a mean of 9.8 months (range, 3-24), with most patients continuing with therapy. Clinical improvement in hair density was observed in 32 patients (80%) (Supplementary Fig 1, available via Mendeley at https://data.mendeley.com/datasets/k8m7rby4bf/1), with a hair loss stabilization in the remaining 8 patients (20%). Adverse effects were reported in 10 children (25%), most commonly facial hypertrichosis (18%), followed by shedding (2 patients) and hypotension (1 patient). Adverse effects were mild in all patients, with no need to discontinue the treatment in any case, and just with 1 patient requiring dose adjustment. Oral minoxidil in adults is typically prescribed at doses of 0.25 to 1.25 mg in women and 2.5 to 5 mg in men, with response rates similar to those in our study.3Randolph M. Tosti A. Oral minoxidil treatment for hair loss: a review of efficacy and safety.J Am Acad Dermatol. 2021; 84: 737-746Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar,4do Nascimento I.J.B. Harries M. Rocha V.B. et al.Effect of oral minoxidil for alopecia: systematic review.Int J Trichology. 2020; 12: 147-155Crossref PubMed Scopus (6) Google Scholar There is just 1 published case series of LDOM use in children, consisting of 8 girls with loose anagen hair syndrome, 7 (87.5%) of whom had improvement in global hair density.5Jerjen R. Koh W.L. 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: 977-978Crossref PubMed Scopus (3) Google Scholar Furthermore, previous studies have reported a similar safety profile, with mainly mild side effects, most commonly hypertrichosis (ranging 4%-93%).3Randolph M. Tosti A. Oral minoxidil treatment for hair loss: a review of efficacy and safety.J Am Acad Dermatol. 2021; 84: 737-746Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar, 4do Nascimento I.J.B. Harries M. Rocha V.B. et al.Effect of oral minoxidil for alopecia: systematic review.Int J Trichology. 2020; 12: 147-155Crossref PubMed Scopus (6) Google Scholar, 5Jerjen R. Koh W.L. 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: 977-978Crossref PubMed Scopus (3) Google Scholar The limitations of our study are its retrospective nature, the lack of patients <10 years of age, and the difficulty in drawing conclusions regarding effectiveness. Although more studies should be performed to assess the safety profile of LDOM in children, its nonhormonal mechanism of action is very attractive in this population. None disclosed.