Topical minoxidil in alopecia areata: a double-blind trial

Abstract

Early reports of the success of topical minoxidil in alopecia areata have been followed by a mixture of enthusiasm and disappointment. Our double‐blind trial was prompted by remaining doubts about its effectiveness and safety. Fifty adult patients (22 male, 28 females) with longstanding alopecia areata (mean age at onset 20 years, mean duration 16 years) took part in the trial. The severity of their disease was categorised as universalis (23 patients), totalis (10), ophiasiform (6) and severe patchy alopecia (11). Thirty‐eight per cent had a personal history of atopy and 14% had circulating thyroid antibodies. For the first 2 months patients were randomly allocated to treatment wjth i % minoxidil in Unguentum Merck® or Unguentum Merck® alone. At the end of this period the same treatment was continued if hair growth was observed; if not, the alternative treatment was used. After 4 months, if no hair growth had occurred, 1% minoxidil was prescribed. Forty‐eight patients were treated for at least 6 months, 46 for 10 months and 13 for longer periods. Equal proportions of the patients treated with minoxidil or with placebo experienced regrowth, but this was substantial only in seven patients and cosmetically acceptable in only two. No patient felt able to stop wearing a wig. Many patients disliked the greasy nature of the preparation. Patients with alopecia universalis had the highest prevalence of nail changes, and the worst response to treatment.