Topical Minoxidil Solution Research Articles

Efficacy and safety of oral minoxidil versus topical solution in androgenetic alopecia: a meta-analysis of randomized clinical trials.

The benefits and potential risks of oral minoxidil therapy versus topical minoxidil therapy in patients with androgenetic alopecia (AGA) are controversial. We systematically searched PubMed, Embase, and Cochrane for randomized clinical trials (RCTs) comparing the use of oral minoxidil and minoxidiltopical solution in patients with AGA. Statistical analyses were performed using R Studio 4.3.2. Standard mean difference (SMD) and risk ratio (RR) with 95% confidence intervals (CI) were pooled across trials. This meta-analysis included four RCTs reporting data on 279 patients. Follow-up ranged from 24 to 39 weeks. There were no differences in hair density (SMD 0.02; 95% CI -0.25 to 0.29; P = 0.88; I2 = 0%) or hair diameter (SMD -0.25; 95% CI -0.75 to 0.26; P = 0.34; I2 = 36%). The incidence of hypertrichosis was statistically significantly higher in the oral minoxidil group when compared to the topical minoxidil group (RR 2.01; 95% CI 1.18-3.41; P = 0.01; I2 = 0%). There was no statistically significant difference between groups for the incidence of hypotension (RR 2.42; 95% CI 0.26-22.46; P = 0.44; I2 = 0%). In patients with AGA, oral minoxidil and minoxidil topical solution have similar efficacy and safety, with equivalent improvements in hair density, hair diameter, and incidence of adverse events, such as hypotension.

Comparison of Efficacy of Topical Betamethasone Dipropionate and Topical Minoxidil in Patients With Alopecia Areata.

Background and objective Alopecia areata (AA) is a reiterative and nonscarring type of hair loss that can affect any hairy area of the body, particularly the scalp. It manifests as patchy or confluent hair loss with variations in demographics and ethnicity. There are numerous treatment options available, including topical and systemic steroids, topical minoxidil, dithranol, tacrolimus, psoralen and ultraviolet therapy (PUVA), contact immunotherapy, and oral immunosuppressive drugs. However, no previous contrast for efficacy is present between the topical betamethasone versus topical minoxidil alone in our population. This study aims to compare the efficacy of topical betamethasone dipropionate versus topical minoxidil in patients with AA. Methodology A nonrandomized controlled study was conducted at the Department of Dermatology, Jinnah Hospital Lahore, incorporating the data of patients between July 26, 2016, and January 26, 2017, after obtaining institutional ethical approval. One hundred patients with alopecia, either on the scalp or any other hairy part, from both genders, aged between 18 and 50 years, were included in the study. Two groups were created, and patients were assigned to these groups based on the clinician's choice. Group A patients were administered betamethasone dipropionate (0.05%) lotion twice daily on affected areas for 12 weeks. Group B patients were administered minoxidil (5%) solution twice daily on affected areas for 12 weeks. A four-week follow-up plan was followed. A five-point scale score system was used for alopecia grading. After 12 weeks, the hair regrowth score (RGS) was used to compare the efficacy of treatment between the two groups. Results A total of 100 patients with grades S1 to S3 AA of less than three months duration were enrolled. Two groups were created, with 50 patients in each group. The mean age in Group A was 29.08 ± 6.51 years, while in Group B, it was 29.38 ± 6.62 years. In Group A, there were 76% males and 24% females, while in Group B, there were 74% males and 26% females. Comparison of efficacy of topical betamethasone dipropionate versus topical minoxidil in patients with AA demonstrated a greater efficacy of 74% (Grade 3 and Grade 4 responses) in Group A, while in Group B, only 42% of patients showed efficacy. A statistically significant difference was found, with a P-value of 0.001. No serious side effects were noted. Conclusions Our study concluded that topical betamethasone dipropionate (0.05%) lotion has statistically significantly higher efficacy compared to topical minoxidil (5%) solution in patients with AA.

Effect of Microneedle on Hair Regrowth in Patients with Androgenetic Alopecia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract Objective Our objective was to assess the effectiveness and safety of microneedle by comparing microneedle plus 5% topical minoxidil treatment and microneedle alone to 5% topical minoxidil. Methods We searched databases such as Embase, PubMed, Cochrane library, VIP Database for Chinese Technical Periodicals, Wanfang, and China National Knowledge Infrastructure in relation to literature. The control group received 5% topical minoxidil solution, whereas the treatment group received either microneedle coupled with minoxidil or microneedle alone. The increase in hair count and hair diameter was the main evaluation criterion for assessing hair regrowth. Data were pooled with Stata 15 software. Results Eight studies with 472 participants were included. Compared with 5% topical minoxidil therapy, microneedle plus minoxidil treatment showed a significant increase in hair count (standard mean difference [SMD] :15.82, 95% confidence interval [CI]: 12.34, 19.31, p < 0.05), but no increase in hair diameter (SMD: −0.21, 95% CI: −2.94, 2.52, p = 0.879 > 0.05). The results of subgroup analysis suggested that microneedle plus minoxidil treatment showed a significant increase in hair count whether the depth of microneedle was less than 1 mm (SMD:1.16, 95% CI: 0.86, 1.42, p < 0.05) or more than 1 mm (SMD:0.52, 95% CI: 0.23, 0.82, p < 0.05). In terms of treatment period subgroup, microneedle combined with minoxidil therapy significantly increased hair count and hair diameter than single 5% topical minoxidil, whether in 12-week period (SMD: 1.08, 95% CI: 0.76, 1.39, p < 0.05) or 21 to 24 weeks period (SMD: 0.64: 95%, CI: 0.35, 0.92, p < 0.05). Conclusion According to this study, the effect of microneedle treatment alone on androgenetic alopecia (AGA) may be limited. However, microneedle plus 5% topical minoxidil treatment had better hair regrowth in hair count and can be considered as an additional therapy option for AGA. Combined with subgroup analysis results, 12-week period and less than 1 mm depth of microneedle penetration were recommended.

Ingestion of minoxidil associated with elevated transaminases in the absence of ischemic hepatitis

Minoxidil is a direct-acting vasodilator that induces relaxation of the vascular endothelium, and historically, it has been used as an antihypertensive agent. It caused hypertrichosis, resulting in its typical use today as an alopecia treatment. Toxicity is characterized by hypotension and tachycardia, often requiring treatment with α-adrenergic agonists. A previously healthy 18-year-old woman presented to the emergency department three hours after ingesting 60 mL of 5% W/V topical minoxidil solution. Initial vitals included sinus tachycardia at 117 beats per minute and a blood pressure of 92/44 mmHg. Laboratory analyses performed three hours post-ingestion revealed elevated aspartate and alanine aminotransferases (224 and 384 IU/L, respectively). Acetaminophen and ethanol concentrations were undetectable. Isotonic crystalloid, N-acetylcysteine, phenylephrine, and midodrine were administered. She developed pulmonary edema, requiring diuresis and supplemental oxygen via a nasal cannula. She was discharged 108 hours post-ingestion after a full recovery. Minoxidil toxicity may be an uncommon etiology of abnormal transaminase concentrations.

DKK1-targeting cholesterol-modified siRNA implication in hair growth regulation

Despite advancements in medical research, androgenetic alopecia (AGA) remains a humankind problem that still needs to be overcome. To date, clinical practice lacks an ideal treatment for AGA. The Wnt/β-catenin signaling pathway is evidenced to play a key role in hair regrowth, hence, modulating this signaling pathway for AGA therapy appears to be rational. One of the major inhibitors of the canonical Wnt/β-catenin signaling pathway is dickkopf-related protein 1 (DKK1). In this report, we have selected a small interfering RNA (siRNA) targeting DKK1 in vitro via qPCR and then tested its efficacy in vivo on the depilated dorsal skin of the mice. The changes in hair growth in different groups were observed over time. Moreover, the visual observation of the hair growth and hematoxylin and eosin (HE) staining showed that DKK1-targeting siRNA reveals non-inferior results compared with the mice treated with the Food and Drug Administration (FDA)-approved, commercially available minoxidil (5%) topical solution that was used as a positive control. Both– positive control and DKK1-targeting siRNA groups demonstrated significantly superior results compared with the control group that received negative control siRNA. Consequently, siRNAs targeting DKK1 may promote hair growth regulation in the AGA population via potentially activating the Wnt/β-catenin signaling pathway.

Efficacy, Tolerability, and Superiority of Propylene Glycol-Free, North American Witch-Hazel (Hamamelis virginiana)-Based Solution of 5% Minoxidil Sulfate for the Treatment of Female Androgenetic Alopecia.

Androgenetic alopecia leads to progressive hair loss in susceptible individuals if left untreated. Topical minoxidil represents an evidence-based treatment for female androgenetic alopecia, though with variable success. Treatment of minoxidil non-responders remains challenging, as does treatment of patients with propylene glycol sensitivity or irritable scalp syndrome. Single-center, retrospective cohort of 50 female patients with androgenetic alopecia failing to respond to a minimum of 6 months of standard 5% topical minoxidil solution either once daily or b.i.d. depending on the severity of the alopecia. Patients were switched to propylene glycol-free, North American Witch Hazel (Hamamelis virginiana)-based solution of 5% minoxidil sulfate (5% minoxidil sensitive solution). Efficacy and safety of treatment were evaluated, including stereotactic global photography and epiluminiscence microscopy with digital imaging taken at baseline, at 3, and at 6 months of treatment. 70% of patients showed observable clinical improvement with combined global photographic and epiluminiscence microscopic assessment with digital imaging, and 22% epiluminiscence microscopic-only improvement as evidence of treatment efficacy. The treatment was well tolerated, particularly in patients with propylene glycol sensitivity and patients with irritable scalp syndrome. These results suggest that propylene glycol-free, North American witch hazel (Hamamelis virginiana)-based solution of 5% minoxidil is effective and safe for treatment of female androgenetic alopecia, specifically in minoxidil non-responders and patients with propylene glycol sensitivity or irritable scalp syndrome.

Dissolving Microneedle Patch Integrated with Microspheres for Long-Acting Hair Regrowth Therapy

Androgenetic alopecia (AGA) is the most common type of progressive hair loss in both men and women that severely reduces life quality and affects patients' self-esteem. Due to the shortcomings of traditional therapeutic formulations (e.g., topical minoxidil and oral finasteride), such as low bioavailability, frequent dosing, and significant side effects, there is an urgent need to develop a safe and effective strategy for AGA treatment. Here, we report a water-soluble microneedle (MN) patch integrated with biodegradable minoxidil (MXD)-loaded microspheres for long-acting AGA treatment with reduced administration frequency and improved patient compliance. When the patch pierces the skin, the MNs rapidly dissolve and deliver MXD-encapsulated polylactic-co-glycolic acid (PLGA) microspheres into the skin, which, subsequently act as drug reservoirs for the sustained release of the therapeutics for over 2 weeks. Additionally, the application of the MN patch provided a mechanical stimulation on mouse skin, which was also helpful for hair regrowth. Compared with the topical MXD solutions that have been commercialized on the market and require daily application, the long-acting MN patch contains a much lower drug amount and shows a similar or superior hair regeneration effect in AGA mice while only requiring monthly or weekly administration. These encouraging results suggest a simple, safe, and effective strategy for long-acting hair regeneration in clinics.

Randomized trial of microneedling combined with 2% minoxidil topical solution for the treatment of female pattern hair loss in a Chinese population.

To evaluate the efficacy and safety of 2% minoxidil combined with microneedling in the treatment of female pattern hair loss. Forty female patients with female pattern hair loss were randomly divided into two groups with 20 patients each. The control group was treated with 2% minoxidil. The combined treatment group was treated with weekly microneedling in addition to daily minoxidil. The treatment period of both groups was 24 weeks. There were no significant differences in age or duration of disease between the two groups of patients. The effective rate in the combined treatment group was 85%, which was significantly higher than that of the control group (45%). The hair counts were also higher in the combined treatment group. All of the adverse reactions observed during the treatment period were mild. No severe adverse event was observed in either group. Microneedling combined with minoxidil had better efficacy for female pattern hair loss during the treatment period and follow-up. Microneedling combined with minoxidil therapy was safe and effective.

Dermoscopic evaluation of the efficacy of combination of topical spironolactone 5% and minoxidil 5% solutions in the treatment of androgenetic alopecia: A cross sectional-comparative study.

Androgenetic alopecia (AGA) is a common chronic dermatological illness that affects both men and women. To assess and compare dermoscopically the impact of a combination of topical minoxidil solution (5%) and topical spironolactone solution (5%) in treating AGA in both sexes. One hundred and twenty patients diagnosed with AGA were divided into three groups; each group is composed of 40 patients. Group A (n=40) were treated with a 5% topical minoxidil solution, group B (n=40) were treated with a 5% topical spironolactone solution, and group C (n=40) were treated with a 5% topical minoxidil and spironolactone combination. Following the initiation of treatment and at 6 weeks (midterm), reduction in all dermoscopic features was observed in all groups; however, it was not statistically significant except for vellus hair reduction (p=0.033). On the contrary, upright regrowing hairs were insignificantly increased in all groups (p=1.088). The pattern of dermoscopic features remained to insignificantly decrease toward the end of 12 weeks treatment (full term) in all studied groups except for vellus hair that showed further significant reduction toward the end of the study (p=0.011). Both spironolactone as a 5% topical solution and minoxidil as a 5% topical solution might be used safely in a twice-daily dosage to treat AGA in both genders. Furthermore, combining them in a single topical dose form can boost efficacy and yield greater advantages.

Effects of microneedling with 5% minoxidil topical solution combination therapy in treatment of androgenetic alopecia.

Microneedling (MN) therapy is one of minimal invasive operations with needles rolled over skin to puncturing the epidermis, and it is becoming a widely used treatment during various dermatological diseases includes androgenetic alopecia (AGA). The purpose of the current study is to investigate the clinical observation and safety of MN combined with 5% minoxidil on triggering hair growth in AGA patients. This retrospective study has analyzed 18 AGA patients who were treated by MN in combination with 5% minoxidil topical solution between July 2021 and February 2022. All patients received six sessions of treatment under aseptic condition at an interval of 1 week. Assessment of hair regrowth was done at the baseline and 10 weeks by photography, investigator, and patient assessment global scoring table on clinical improvement, and the patient's final satisfaction was investigated. According to the standardized 7-point scale, mean scores of investigator and participant assessments were 1.44 ± 0.61 and 1.66 ± 0.59, respectively, indicating that the hair appearance was considerably improved by MN combined with 5% minoxidil treatment. Fifteen patients (83.3%) were satisfied with the improvement in hair growth. No severe adverse events were noted in patients during and after the procedure. The combination of the length of 1.5 mm MN and 5% minoxidil in the treatment of AGA showed efficacy with high safety, which is worthy of clinical application.

A randomized clinical trial on therapeutic effects of 0.25 mg oral minoxidil tablets on treatment of female pattern hair loss.

Topical minoxidil solution is recommended treatment for female pattern hair loss. However, some complications, such as skin allergies, have prevented some patients from completely receiving this treatment. This study intends to evaluate the therapeutic and side effects of oral minoxidil 0.25 mg tablets treatment on FPHL and compare it with conventional treatment of 2% topical minoxidil. This study is a triple-blind randomized clinical trial in which 72 women with FPHL were treated as two separate groups. Group 1 was treated with oral minoxidil 0.25 mg tablets and topical placebo solution, while topical minoxidil solutions and oral placebo tablets were used to treat group 2 patients. In the oral minoxidil group, the average hair diameter and hair density after the 9-month treatment reached from 0.044 mm and 102 per cm2 to 0.048 mm and 115 per cm2 , respectively. In the topical minoxidil group, the average hair diameter and hair density from initial values of 0.044 mm and 107 per cm2 increased to 0.047 mm and 113 per cm2 . In both groups, the changes of hair diameter and hair density were significant compared to initial values (p <0.001), while the trend of changes was not statically different between the two groups (p =0.077, p =0.674 for hair diameter and hair density, respectively) and side effects were trivial. In conclusion, oral minoxidil is an effective and new treatment for FPHL, even with a minimal dose, which can be used as an alternative treatment, especially for patients with poor compliance against topical minoxidil.

Comparison of the therapeutic effects of Minoxidil 5% solution alone with Flutamide 2% and Minoxidil 5% mixed solution in patients with androgenetic alopecia referring to dermatology clinic of Isfahan university of medical sciences

Introduction: A special type of alopecia called androgenetic alopecia is one of the most common skin and hair diseases, and topical minoxidil solution is one of the best treatments. Studies have shown that the use of topical 5% minoxidil solution in patients with androgenetic alopecia reduces hair loss, increases patients' satisfaction with recovery and increases hair growth. Also, the therapeutic effects of flutamide in women with hair loss have been shown that flutamide is a very suitable treatment regimen for the treatment of these patients and its low doses are very suitable and have few side effects. Accordingly, the aim of this study was to compare the therapeutic effects of 5% minoxidil solution with the combined solution of minoxidil 5% and flutamide 2% in patients with androgenetic alopecia referring to Isfahan Skin Clinic. Methods: This study was a randomized double-blind clinical trial that was conducted as a preliminary study from the summer of 1397 to the summer of 1398 in Al-Zahra Hospital. After identifying patients with mild to moderate androgenetic alopecia as a simple coincidence available to 40 people, they were randomly divided into two groups of cases and 20 subjects. Patients in the control group received 5% minoxidil solution, 1 cc each 20 drops 2 times a day, and patients in the combined group received 2% flutamide and 5% minoxidil in the same way for 9 months. The required data were collected based on the checklist. After collecting the data in SPSS software, version 22 was examined at a significance level of 0.05. Results: There was no significant difference between gender, age, hair thickness in the two groups of case and control (P>0.05), but there was a significant difference between hair thickness in the two groups of case and control after intervention (P 0.05), but there was a significant difference after the intervention (P 0.05). There was a significant difference between hair size in the case and control group before and after the intervention (P 0.05). Conclusion: According to the results of this study and since conducting this study was an introduction to better understanding the therapeutic effects of minoxidil and flutamide in the treatment of androgenetic alopecia and comparing its therapeutic effects in men and women with androgenetic alopecia, so the necessary measures can be taken. He used a combination of these two drug solutions.

Comparative study of efficacy of topical minoxidil versus topical minoxidil with finasteride in androgenetic alopecia

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Minoxidil and finasteride are most common drugs used in androgenetic alopecia. The objective of the study was to know the efficacy of topical minoxidil solution with and without finasteride.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In total about 30 subjects, aged 18-45 years, who came for outpatient consultation for male pattern androgenetic alopecia were randomized into two groups. Group A was treated with 0.1% topical finasteride and 5% minoxidil solution and Group B was treated with 5% minoxidil solution after taking informed consent from subjects of both groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Analysis of the extent of bald area, hair count and number of terminal hair showed better results in group A compared to group B.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Better results were obtained with combination of topical minoxidil with finasteride than with plain topical minoxidil.&lt;/p&gt;

Role of Low-Level Light Therapy (LLLT) in Androgenetic Alopecia.

Androgenetic alopecia (AGA) is the commonest type of alopecia affecting over half of men and women. Only two drugs have been approved so far (minoxidil and finasteride), and hair transplant is the other treatment alternative. Low-level laser therapy (LLLT) has been claimed to be a new safe devise-based modality for stimulating hair growth in men and women in AGA. Searches of PubMed and Google Scholar were carried out using keywords alopecia, hair loss, and LLLT. Fifteen studies were found to be strongly relevant and were analyzed. Studies have shown that LLLT stimulated hair growth in both men and women. Studies with largest randomized controlled trials demonstrated statistically significant hair regrowth by terminal hair count in both males and females. One study also showed that LLLT and minoxidil had similar efficacy in hair growth and that combination therapy was even more effective. LLLT represents a non-invasive, safe, and potentially effective treatment option for patients with AGA who do not respond or are not tolerant to standard treatment of AGA. Moreover, combining LLLT with topical minoxidil solution and oral finasteride may act synergistic to enhance hair regrowth. However, the level of evidence of the studies is still low and hence more controlled large studies are needed.

Accidental Consumption of Distinguished Substance in Disguise- A Rare Case of Minoxidil Poisoning

Minoxidil is a powerful direct acting vasodilator that was used clinically as an oral antihypertensive drug in combination with beta blockers and diuretics in cases of hypertension refractory to other antihypertensives. A 58-year-old male presented to the Emergency Department with an alleged history of accidental consumption of around 10 mL of 5% topical minoxidil solution. He had developed tachycardia, severe hypotension, and characteristic Electrocardiogram (ECG) changes with no obvious chest pain. He was treated with continuous intravenous (i.v.) crystalloids, dual inotropes and other supportive measures. The patient also developed acute pulmonary oedema and acute kidney injury. He responded to treatment and gradually improved haemodynamically with resolution of ECG changes and acute kidney injury. He was discharged seven days after admission. The patient showed resolution of characteristic ECG changes and improvement in haemodynamic condition of patient with supportive management in hospital.

A comparative study of efficacy and safety of 5% topical minoxidil with platelet rich plasma versus platelet rich plasma as a monotherapy in male patients with androgenetic alopecia

Introduction: Male baldness is genetically determined, most common gradually progressive hair disorder leading to miniaturization of hair follicles. Various modalities have been used in various studies without significant results. Objective: The aim was to study and compare the two modalities of treatment and to evaluate their results. Materials and Methods: This is prospective, comparative study. Sample size was 40, twenty in each group. Group 1 was given 5% topical minoxidil solution two times in a day till six months and platelet rich plasma (PRP), Group 2 was given only PRP at three weekly interval for six months. Parameters evaluated before starting, after three months and after six months for - Hair pull test, anagen/telogen ratio, Patient’s, Physician’s assessment and clinical photographs. Results: On evaluating group 1 showed relatively more significant improvement. On hair pull test significant reduction of hair breakage in group 1. Anagen/telogen ratio showed 8.9 ± 0.3% improvement in anagen hair in group 1 while 5.9 ± 0.5% was in group 2. Improvement was seen in patients of group 1 more than patients of group 2 based on patient’s assessment and photographs. Conclusion: 5% minoxidil when given with platelet rich plasma was superior and better when compared to platelet rich plasma alone. Keywords: AGA, PRP, Minoxidil.

Usefulness of home-use microneedle devices in the treatment of pattern hair loss.

Microneedle devices have been used to reduce scarring and wrinkling as well as for the treatment of pattern hair loss. Here, we investigated the efficacy and safety of a newly developed home-use microneedle device for the treatment of pattern hair loss. Twenty-nine patients were assigned into three groups based on block randomization: home-use microneedle device only, a combination of home-use microneedle device and 5% minoxidil solution and 5% minoxidil topical solution only. Each treatment was performed twice a week. The study outcomes included hair counts, patient self-assessments, and adverse events at baseline and at 6months. Statistical analyses were performed using analysis of variance (ANOVA), repeated measures ANOVA and Kruskal-Wallis test. The improvements in hair count were seen in the combination group at month 6, but the differences observed did not reach statistical significance in each group and among the three groups. The patient self-assessment showed the highest score in the combination group, but it did not reveal a statistically significant difference among the three groups. Mild and transient pruritus were reported by one patient who was using the microneedle device only. Our study shows that the home-use microneedle device may be a safe and 5% minoxidil solution penetration-enhancing therapeutic modality for stimulating hair growth.

Minoxidil induced central serous Chorioretinopathy treated with oral Eplerenone \u2013 a case report

BackgroundMinoxidil solution has routinely been used for decades for the treatment of androgenic alopecia. Central serous chorioretinopathy (CSCR) is a rare side-effect noted following prolonged topical minoxidil therapy for androgenic alopecia. In this report, we describe a case of a 41-year-old young man who developed CSCR following prolonged therapy with topical Minoxidil solution and was treated with oral eplerenone.Case presentationA 41-year-old male presented to the retina clinic with complaints of seeing a black spot, blurred vision and metamorphopsia involving the right eye for the past 4 months. He was on treatment for androgenic alopecia with topical 5% Minoxidil application on scalp two times a day. He noticed the symptoms 8 months after starting the treatment and had stopped the medication since the past 2 months. On examination, best-corrected visual acuity was 20/20 in both eyes. Fundoscopic examination of the right eye with +78D lens on slit lamp revealed the presence of subretinal fluid and few focal spots of retinal pigment epithelial alterations. Optical coherence tomography scan evaluation showed the presence of subretinal fluid (SRF) and pachychoroid supporting the diagnosis of CSCR. Indocyanine green angiography revealed dilated hyperpermeable choroidal vasculature on the nasal side of the fovea in the early and later phases of the angiogram. The patient was diagnosed with CSCR as a possible consequence of the topical minoxidil solution. Patient was asked to avoid future use of Minoxidil and was started on oral eplerenone therapy 50 mg/day for 4 consecutive weeks. One month later, there was complete resolution of his symptoms and SRF. At the final follow-up visit, 2 months after starting the therapy, there was no recurrence of SRF.ConclusionCSCR is a rare side-effect noted following prolonged topical minoxidil therapy for androgenic alopecia. While we found oral eplerenone to be safe and effective, further studies would be required before it can be routinely used in the population.

Randomized trial of electrodynamic microneedling combined with 5% minoxidil topical solution for treating androgenetic alopecia in Chinese males and molecular mechanistic study of the involvement of the Wnt/β-catenin signaling pathway

Background Treatment of androgenetic alopecia (AGA) with concurrent electrodynamic microneedling and 5% minoxidil may further stimulate hair growth. Objectives To evaluate the efficacy of microneedling combined with 5% minoxidil in Chinese male AGA patients and to explore the underlying mechanisms. Methods Seventy-one male volunteers with AGA completed the entire trial and follow-up. The first group (n = 23) received only 5% minoxidil twice daily for 24 weeks; the second group (n = 23) received only microneedle therapy every 3 weeks for eight treatments; and the third group (n = 25) received the combination treatment for a total of 24 weeks. Changes in hair density and diameter were evaluated before and after treatment every 3 weeks, and patients were followed up at 6 months after the final treatment. In the combination group, a PCR array was used to detect the expression of molecules in the Wnt/β-catenin pathway within the hair loss sites on top of the head before and after treatment and within the scalp tissues from non-hair loss sites on top of the head. The tissues were obtained by punches in the most severe area of hair loss on top of the head and in the adjacent normal hair area without hair loss. Real-time quantitative PCR and western blotting were used to further examine changes in the differentially expressed molecules identified by PCR array (FZD3) and in molecules in the Wnt/β-catenin signaling pathway closely related to hair growth (β-catenin and LEF-1). Results Compared to single minoxidil or single microneedle treatment, the combination therapy showed superior therapeutic effects clinically, with further upregulation of FZD3, β-catenin, and LEF-1 expression levels at both mRNA and protein levels in the treated areas. Conclusions Microneedling combined with 5% minoxidil can improve AGA, and the underlying mechanism may involve activation of the Wnt/β-catenin signaling pathway.

How safe is prescribing oral minoxidil in patients allergic to topical minoxidil?

To the Editor: We present 9 female patients (Table I) who became allergic to topical minoxidil and were able to tolerate low-dose oral minoxidil without adverse effects.Table IList of patientsPatientAge, y∗Mean age of 47.2 years (range, 22-72 years).SexTopical minoxidil use, yAdverse effects from topical minoxidilOral minoxidil use, 0.25 mg twice daily, mo†All patients currently on treatment.Adverse effects from oral minoxidil148Female8Scalp pruritus15None247Female12Scalp pruritus, scaling20None372Female14Scalp pruritus, scaling33Mild hypertrichosis on temples449Female3Scalp pruritus, eczematous rash on ears10None554Female1.5Scalp pruritus7None655Female0Scalp pruritus18None731Female0Scalp pruritus, eczematous rash on ears8None847Female4Scalp pruritus, scaling24Mild hypertrichosis on cheeks922Female1Scalp pruritus, eczematous rash on ears18None∗ Mean age of 47.2 years (range, 22-72 years).† All patients currently on treatment. Open table in a new tab Topical minoxidil is the only approved treatment for female pattern hair loss.1Friedman E.S. Friedman P.M. Cohen D.E. Washenik K. Allergic contact dermatitis to topical minoxidil solution: etiology and treatment.J Am Acad Dermatol. 2002; 46: 309-312Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar It has a safe profile, and the most common adverse effects include irritant and allergic contact dermatitis and hypertrichosis. Contact dermatitis to commercial minoxidil is often caused by propylene glycol that is present in the 2% and 5% solutions. Patients with contact allergy or irritation to propylene glycol can use the 5% minoxidil foam, which is free of this ingredient. Contact allergy to minoxidil itself is uncommon and requires discontinuation. Our patients had been using topical minoxidil for an average of 4.8 years (range, 1-14 years) (Table I) when an acute contact dermatitis developed. All were patch tested with propylene glycol 30% in water (Chemotechnique Diagnostics, Vellinge, Sweden), 5% commercial minoxidil solution, and 5% commercial minoxidil foam. Patches were removed after 48 hours and the reading was performed at 72 and 96 hours. All 9 patients had a positive patch test result to the 5% minoxidil solution and the foam and a negative patch test result to propylene glycol, indicating that the cause of contact dermatitis was minoxidil itself (Fig 1). Oral minoxidil has been used in the last few years as an off-label treatment both in male and in female pattern hair loss with good clinical efficacy.2Jimenez-Cauhe J. Saceda-Corralo D. Rodrigues-Barata R. et al.Effectiveness and safety of low-dose oral minoxidil in male androgenetic alopecia.J Am Acad Dermatol. 2019; 81: 648-649Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar,3Sinclair R.D. Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone.Int J Dermatol. 2018; 57: 104-109Crossref PubMed Scopus (58) Google Scholar Proposed doses are different in men than in women, with a range from 0.25 to 1 mg daily.4Ramos P.M. Sinclair R.D. Kasprzak M. Miot H.A. Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: a randomized clinical trial.J Am Acad Dermatol. 2020; 82: 252-253Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar Lower doses are used in women because hypertrichosis is a common adverse effect.3Sinclair R.D. Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone.Int J Dermatol. 2018; 57: 104-109Crossref PubMed Scopus (58) Google Scholar Our experience with more than 200 patients on oral minoxidil indicates that 0.5 mg daily is effective and very well tolerated. The possibility that patients with contact allergy to topical minoxidil could safely tolerate oral minoxidil was suggested by the fact that systemic skin reactions to topical or oral minoxidil have never been described. Systemic contact dermatitis refers to a rare diffuse reaction that individuals sensitized to a contact allergen might develop after exposure to the same allergen via a different route. The exact pathophysiology is unknown; however, it appears to be mediated by a type 4 and possibly type 3 hypersensitivity reaction. Cases of systemic contact dermatitis have been reported for propylene glycol5McGowan M.A. Scheman A. Jacob S.E. Propylene glycol in contact dermatitis: a systematic review.Dermatitis. 2018; 29: 6-12Crossref PubMed Scopus (32) Google Scholar but not for minoxidil, so treatment with oral minoxidil was started at the dose of 0.25 mg twice daily. The 0.25-mg capsules were compounded by pharmacies. All of our patients have been using the same dose to date, for an average of 17 months (range, 7-33 months) without any adverse effects. All of them were satisfied with results of treatment. Cardiac adverse effects of oral minoxidil, such as edema, pericarditis, or pericardial effusion, are dose-dependent and have never been reported with low doses. Our experience therefore suggests that oral minoxidil is reasonably safe in patients allergic to topical minoxidil, even if it is advisable to warn patients to stop the medications in case of cutaneous adverse effects.