Use Of Minoxidil Research Articles

Low-dose oral minoxidil as treatment for non-scarring alopecia: a systematic review.

Topical minoxidil has been used for almost 40years to treat alopecia. There is growing evidence supporting off-label use of low-dose oral minoxidil. To conduct a systematic review evaluating the use of oral minoxidil for all types of alopecia. A primary literature search was conducted using PubMed in May 2019, utilizing the search term "oral minoxidil AND (hair loss OR alopecia OR baldness)". Reviews, non-English studies, and articles concerning only topical minoxidil were excluded. Ten articles were included for review comprising a total 19,218 patients (215 women and 19,003 men). Oral minoxidil dose ranged from 0.25 to 5mg daily to twice daily. The strongest evidence existed for androgenetic alopecia and alopecia areata (AA), with 61-100% and 18-82.4% of patients demonstrating objective clinical improvement. Successful treatment of female pattern hair loss, chronic telogen effluvium, monilethrix, and permanent chemotherapy-induced alopecia was also reported. The most common adverse effects with oral minoxidil included hypertrichosis and postural hypotension. Oral minoxidil is a safe and successful treatment of androgenic alopecia and AA. In addition to its therapeutic benefits, practical advantages over topical minoxidil stem from improved patient compliance.

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.

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.

575 Topical minoxidil adherence in alopecia patients

Poor patient adherence to topical minoxidil for the treatment of scarring and non-scarring alopecia is a major concern among dermatologists managing these conditions. Although there are a sufficient number of studies evaluating adherence to oral and topical therapies in patients with psoriasis, acne, atopic dermatitis and urticaria1-3, adherence to topical minoxidil among alopecia patients has not been well studied. The primary endpoint of this study is to identify characteristics associated with topical minoxidil adherence and non-adherence among alopecia patients. 100 subjects were recruited from a busy, hair loss clinic. All participants had a diagnosis of hair loss and a history of topical minoxidil use, including current and previous users. Hair loss diagnoses included: androgenetic alopecia, central centrifugal cicatricial alopecia, traction alopecia, frontal fibrosing alopecia or lichen planopilaris. Other forms of alopecia were excluded. The study outcomes, patient characteristics and adherence levels were evaluated by a self-administered socio-demographic survey and the Morisky, Green, and Levine (MGL) Adherence Scale. The latter stratifies patients as high (0 out of 4), medium, (less than or equal to 2 out of 4) or low (greater than or equal to 3 out of 4) for adherence performance. This observational study is the first of its kind to evaluate minoxidil adherence, based on a number of factors (e.g. age, sex, race, marital status, educational level) in patients diagnosed with alopecia.

Off-Label Use of Topical Minoxidil in Alopecia: A Review.

Topical minoxidil is a well-known and often-utilized drug in dermatological practice for the treatment of alopecia. It was approved by the United States Food and Drug Administration for the treatment of androgenetic alopecia in 1988. Since its approval, minoxidil has been used off-label for the treatment of many other types of alopecia, with minimal formal evidence of efficacy. Conditions for which the use of topical minoxidil has been reported include telogen effluvium, alopecia areata (AA), scarring alopecia, eyebrow hypotrichosis, monilethrix, and chemotherapy-induced alopecia(CIA). The evidence for the use of minoxidil in each condition is derived from a variety of studies, including clinical trials, case series, and case reports. A comprehensive review of the literature indicates that while minoxidil is routinely used in the management of many alopecic conditions, there is mixed evidence for its efficacy. For certain conditions, including AA and most scarring alopecias, the evidence seems to be inconclusive. For others, such as eyebrow hypotrichosis, monilethrix, early traction alopecia, and CIA, there is more support for the efficacy of minoxidil. Although the favorable safety profile of minoxidil is established in adults, its use in the treatment of pediatric alopecia may require heightened monitoring and patient education.

Minoxidil in the treatment of androgenetic alopecia.

The National Institutes of Health (US NIH, 2018) estimates that in the US approximately 50 million men and 30 million women suffer from AGA (also known as pattern hair loss). Minoxidil is the only topical drug for the treatment of both female and male pattern hair loss. In the US, minoxidil is approved over-the-counter (OTC) at a maximum concentration of 5%. In this review, we summarize the findings of the pivotal studies used in support of the drug's approval as well as recent discoveries and novel developments in the use of minoxidil for the treatment of AGA.

Minoxidil in trichological practice

Management of patients with alopecia is still a challenging task. Minoxidil is a pyrimidine derivative, a potent KATP channel opener, and has been shown to act as a vasodilating agent. Minoxidil enhances the synthesis of growth factors, not only VEGF (vascular endothelial growth factor), but also FGF (fibroblast growth factor), IGF-1 (insulin-like growth factor), which stimulate growth processes in the hair follicle and trigger the anagen phase. The topical minoxidil formulations have been proven to be particularly efficient to a greater extent in androgenic alopecia (AGA) and to a lesser extent in nasal alopecia (GA).The best hair regrowth has been detected in early stages of alopecia. It generally takes 4-6 months before results are visible, and 12 months to stabilize the hair growth, which is maintained by a regular use of minoxidil. The level of the sulfotransferase enzyme in the hair follicles may predict the outcome of topical minoxidil therapy. The topical use of minoxidil does not cause any systemic side effects, and adverse effects in the form of skin reactions, irritation and dryness are short-term and rare. The article also presents the data of its own clinical experience in using minoxidil for the treatment of alopecia.

Understanding Minoxidil-Induced Pericardial Effusion

Minoxidil is a powerful antihypertensive medication that has been used extensively to control blood pressure in patients with renal failure. Its mechanism of action is through a cyclic AMP-mediated effect on arteriolar smooth muscle, with little effect on veins causing a direct vasodilatation of peripheral blood vessels. Minoxidil use has been associated with cause and/or exacerbation of pericardial effusions both in dialysis patients and those with normal kidney function. We report a 58-year-old African American female with history of severe resistant hypertension that has been controlled by Minoxidil 5 mg po BID, and stage 3 chronic kidney disease who presented with shortness of breath, and headache. Blood pressure 240/124 mmHg. Her CT Brain revealed no intracranial bleed. Electrocardiogram showed normal sinus rhythm, with no ST/T wave changes. Cardiac biomarkers were normal. However, 2D Echocardiogram showed Estimated ejection fraction EF of 65%, moderate pericardial effusion, with no evidence of pericardial tamponade, and moderate Left ventricular hypertrophy. This case reviews and explains the association between Minoxidil use and pericardial effusion, which may need appropriate treatment/monitoring, and extensive work ups to rule out other pathologies.

The use of minoxidil in the treatment of male and female androgenetic alopecia: a story of more than 30 years.

Even if minoxidil has been known for over 30 years as "hair growth stimulator" the precise mechanism of its action is not completely elucitated. Minoxidil shortens telogen, accelerates telogen-exogen phase and causes the premature entry of resting hair follicles into anagen phase. Moreover, minoxidil increases hair follicle size. A large part of hair treatment scientific literature confirms the efficacy of topically applied minoxidil in humans. In particular, patients treated with minoxidil showed a significant increase in "non vellus" hair count starting from baseline. Preparation of minoxidil requires molecule stability and solubility. Today are available on the market minoxidil-based formulations having low-concentration of propylene glycol to obtain preparations with a better cosmetical acceptance and dermatological safety. The body of evidences indicates that minoxidil still represent a milestone in the treatment of androgenetic alopecia and that its story is going on.

Polyethylene glycol as marker for nitrofurazone allergy: 20 years of experience from Turkey.

Polyethylene glycols (PEGs) and propylene glycol (PG) are used as vehicles in various medicinal and cosmetic products. They are potential contact sensitizers, including low molecular weight PEGs in nitrofurazone preparations that are still widely used in Turkey. To investigate the prevalence of allergic contact dermatitis caused by PEG and PG in a relatively large group of patients in Turkey. In this retrospective, cross-sectional, single-centre study, 836 patients patch tested with PEG and PG between 1996 and 2015 were reviewed. Thirty-five patients (4.2%) showed positive patch test reactions to PEG, and 7 (0.8%) showed positive patch test reactions to PG, partly as late positive reactions with PEG. PEG sensitivity was almost exclusively related to nitrofurazone allergy. Patch test reactions to PG were currently relevant mainly with regard to the use of minoxidil, and antiherpetic or corticosteroid creams. Ten patients (25%) had concomitant contact allergies to various topical drugs containing mainly PEGs. PEG sensitivity seems to be a marker for contact allergy to topical nitrofurazone in Turkey. Nitrofurazone allergy appears to favour concomitant sensitization to PEG. We would suggest the inclusion of PEG in an extended baseline patch test series in Turkey. Late patch test readings are important to diagnose delayed positive reactions to PEG.

Comparison of topical agents minoxidil and diltiazem in medical management of anal fissures: a hospital based study

Background: Anal fissures are associated with spasm of the internal anal sphincter and pain. In present study we compared the efficacy of local application of 0.5% minoxidil and 2% diltiazem in symptomatic relief and healing of anal fissures.Methods: In this prospective, randomized, double blind study, a total of 100 patients with anal fissure were recruited, (50 patients in each group). Patients in group A received local applications of ointments containing 0.5% minoxidil, while patients in group B received topical 2% Diltiazem. Healing of anal fissure and symptomatic relief were observed and analyzed.Results: Rates of complete healing of fissure were similar in the two groups (minoxidil 27/50, diltiazem 29/50). Mean (SD) time taken for complete healing was significantly shorter with minoxidil (3.1 weeks as compared to diltiazem (4 weeks). Rates of pain relief were similar in the two groups. Stoppage of bleeding occurred more often with use of minoxidil than with diltiazem. No patient had systemic or local side effects.Conclusions: Treatment with minoxidil helps in faster healing of anal fissures and provides similar symptomatic relief as that of diltiazem.

Controlled clinical trial for evaluation of hair growth with low dose cyclical nutrition therapy in men and women without the use of finasteride

Aim: To evaluate possible results with the stimulation use of minoxidil and the strengthening of hair roots with nutritional cyclical supplements, resulting in increased hair regrowth, without the use of anti androgens and enzyme blockers.

Bioactives in Chinese Proprietary Medicine Modulates 5α-Reductase Activity and Gene Expression Associated with Androgenetic Alopecia.

Androgenetic alopecia (AGA) is characterized by a progressive and patterned transformation of thick, pigmented terminal scalp hairs into short, hypo-pigmented vellus-like hairs. The use of Minoxidil and Finasteride to treat AGA are often associated with complications in safety and efficacy. However, herbal remedies are deemed to have lesser side effects in many societies. This study aims to identify potential hair growth properties of individual compounds from a Chinese proprietary medicine known as Yangxue Shengfa capsule (YSC), used in China for many years for improving AGA. Six marker compounds, including 2,3,5,4'-tetrahydroxystilbene-2-O-β-D-glucoside (TSG), Chlorogenic acid, Emodin, Ferulic acid, Isoimperatorin, and Paeoniflorin were used for simultaneous HPLC quantification and anti-AGA in-vitro screening. Simultaneous quantification of these components was performed on 75% (v/v) methanol extracts of YSC, using a Welch Ultimate XB-C18 column and gradient elution. Five compounds significantly promoted cell proliferation in cultured immortalized human Dermal Papilla Cells (DPC). Multiple genes associated with the progression of AGA, including IGF-1, DKK-1, and TGF-β1, were found to be regulated by some of these compounds. Interestingly, Ferulic acid and Emodin demonstrated good pharmacological properties against AGA, thereby concluding the potential of these bioactives to be used in the treatment against AGA.

Anti-PDGF receptor β antibody-conjugated squarticles loaded with minoxidil for alopecia treatment by targeting hair follicles and dermal papilla cells

This study developed lipid nanocarriers, called squarticles, conjugated with anti-platelet-derived growth factor (PDGF)-receptor β antibody to determine whether targeted Minoxidil (MXD) delivery to the follicles and dermal papilla cells (DPCs) could be achieved. Squalene and hexadecyl palmitate (HP) were used as the matrix of the squarticles. The PDGF-squarticles showed a mean diameter and zeta potential of 195nm and −46mV, respectively. Nanoparticle encapsulation enhanced MXD porcine skin deposition from 0.11 to 0.23μg/mg. The antibody-conjugated nanoparticles ameliorated follicular uptake of MXD by 3-fold compared to that of the control solution in the in vivo mouse model. Both vertical and horizontal skin sections exhibited a wide distribution of nanoparticles in the follicles, epidermis, and deeper skin strata. The encapsulated MXD moderately elicited proliferation of DPCs and vascular endothelial growth factor (VEGF) expression. The active targeting of PDGF-squarticles may be advantageous to improving the limited success of alopecia therapy. From the Clinical EditorTopical use of minoxidil is only one of the very few treatment options for alopecia. Nonetheless, the current delivery method is far from ideal. In this article, the authors developed lipid nanocarriers with anti-platelet-derived growth factor receptor ? antibody to target dermal papilla cells, and showed enhanced uptake of minoxidil.

Localized telogen effluvium after face lift surgery.

Dear Editor: A 62-year-old woman presented at Kyung Hee University Hospital at Gangdong with a 2-month history of frontal and bitemporal shedding and thinning. Two months prior to visiting our clinic, she had undergone rhytidectomy at a local plastic surgery clinic. Her past medical history was not significant. There was no drug history, weight change, or chronic illness, and the patient denied any other trauma history. The physical examination revealed symmetric frontal and bitemporal thinning and decreased hair density (Fig. 1A, B). In a hair pull test, ≥10 hairs were easily pulled from around the suture line of the rhytidectomy; however, the hair pull test was negative in other parts of the scalp. On transverse sections of a 5-mm punch biopsy specimen, normal follicular density and increased numbers of telogen hair follicles were observed. Peribulbar inflammation, scarring, and hair shaft abnormality were not observed (Fig. 1C). On the basis of the clinical and histopathologic findings, she was diagnosed with telogen effluvium, which occurred after rhytidectomy. Without any treatment, the patient noted the natural recovery of hair shedding, and the regrowth of many hairs was observed around the affected areas 4 months after rhytidectomy (Fig. 2). Fig. 1 (A, B) Hair thinning and a decreased hair density is observed symmetrically along the frontal and bitemporal incision lines. (C) Increased numbers of telogen hair follicles are found, and peribulbar inflammation, scarring, and hair shaft abnormality are ... Fig. 2 Three months after the rhytidectomy, hair regrowth is detected around the frontal and bitemporal incision lines. Temporary hair loss following rhytidectomy has been reported to occur in up to 8.4% of patients after rhytidentomy1. Several causes have been suggested, which include undue tension at the time of flap closure, excessively thin flaps with a diminished blood supply to the hair follicles, and direct trauma to the hair follicles during dissection2. Telogen effluvium is also known as the cause of temporary hair loss after rhytidectomy3. The hallmarks of an acute telogen effluvium include diffuse shedding sometimes with accentuated hair thinning, a normal appearing scalp, and a markedly positive pull test4. Possible causes include a high fever, postpartum, severe illness, severe psychological distress, major surgery, thyroid disease, drugs, and crash diets4. It is a reversible disorder once the initiating factor is eliminated and no specific treatment is needed. In this case, hair loss began 2 months postoperatively, and a scalp biopsy at the beginning of the hair loss revealed an increased ratio of telogen hair follicles and few peribulbar inflammatory cell infiltrates. Without any treatment, the hair shedding ceased and regrowth of the hairs was observed around the frontal and bitemporal incision lines. Based on all this evidence, the authors concluded that localized telogen effluvium could have been the cause of temporary hair loss after rhytidectomy. Moreover, a study reported that preoperative and postoperative prophylactic use of minoxidil reduces the percentage of hair loss that occurs after rhytidectomy5, and this finding also supported our conclusion. Herein, we report on the first case of telogen effluvium that occurred after rhytidectomy with histopathologic findings and a natural course of recovery. Dermatologic surgeons should be aware that localized telogen effluvium can cause temporary hair loss after face lift surgery. To prevent temporary hair loss, surgeons must reduce the trauma to the hair follicles by making incisions that are parallel to the hair follicles, reduce tension to the scalp around the suture lines, and ensure that the skin flap is not too thin.

Acute telogen effluvium onset event is associated with the presence of female androgenetic alopecia: potential therapeutic implications.

Acute telogen effluvium (ATE) is often associated with female androgenetic alopecia (FAA), but predictive factors of ATE-FAA association and clinical factors or therapies that may influence the progression of ATE to chronic telogen effluvium (CTE) have not been reported. We have identified predictive factors of ATE-FAA association and retrospectively evaluated the impact of therapies on the progression to CTE. Conclusions are as follows: (i) Triggering cause is a significant independent factor that predicts association of ATE with FAA. (ii) Triggering causes with higher risk of concurrent FAA are severe diet, iron deficiency, and thyroid dysfunction. (iii) Patients suffering ATE may benefit from different therapeutic approaches (depending on which is the triggering cause) to prevent or treat the association with FAA. (iv) Minoxidil use shows a trend to lower the percentage of progression to CTE. (v) Apart from treating the precipitating cause, the different additional oral treatments used have not shown any correlation with progression to CTE.

Minoxidil Use in Dermatology, Side Effects and Recent Patents

Minoxidil, a vasodilator medication known for its ability to slow or stop hair loss and promote hair regrowth, was first introduced, exclusively as an oral drug, to treat high blood pressure. It was however discovered to have the important side-effect of increasing growth or darkening of fine body hairs; this led to the development of a topical formulation as a 2% concentration solution for the treatment of female androgenic alopecia or 5% for treating male androgenic alopecia. Measurable changes disappear within months after discontinuation of treatment. The mechanism by which it promotes hair growth is not fully understood. Minoxidil is a potassium channel opener, causing hyperpolarization of cell membranes and it is also a vasodilator, it is speculated that, by widening blood vessels and opening potassium channels, it allows more oxygen, blood and nutrients to the follicle. This can also cause follicles in the telogen phase to shed, usually soon to be replaced by new, thicker hairs in a new anagen phase. It needs to be applied regularly, once or twice daily, for hair gained to be maintained, and side effects are common. The most common adverse reactions of the topical formulation are limited to irritant and allergic contact dermatitis on the scalp. There have been cases of allergic reactions to the nonactive ingredient propylene glycol, which is found in some topical solution especially if they are galenic. Increased hair loss which can occur during Minoxidil use, is due to the synchronization of the hair cycle that the treatment induces. In this review, we described its mechanism of action, use in dermatology and some patents related to alternative treatment of allergic reactions due to its use.

Markers of uremia and pericardial effusion in peritoneal dialysis

Inadequate dialysis causes accumulation of toxic residues that may lead to the development of dialysis-associated pericardial effusion, but several other factors could be associated with this abnormality. The purpose of this study was to evaluate clinical risk factors to asymptomatic pericardial effusion in peritoneal dialysis. This cross-sectional study included 34 patients aged ≥ 18 years on peritoneal dialysis for at least 3 months, who showed no symptomatic pericardial effusion, hepatic cirrhosis, neoplasias, lupus or amputations, none in minoxidil use. Asymptomatic pericardial effusion was diagnosed by echocardiography. Risk factors were evaluated by logistic regression and Roc curve. Significance level was set at P < 0.05. Patient age was 51 ± 15.9 years. Of the 34 patients enrolled, 16 were men and 11 diabetic. Five of them presented pericardial effusion. Logistic regression identifies low hemoglobin level (RR 0.454 CI 95%: 0.225-0.913; P = 0.027), low phase angle (RR 0.236 CI 95%: 0.057-0.984; P = 0.048) and low Kt/V (RR 0.001 CI 95%: 0.0-0.492; P = 0.03) as risk factors to pericardial effusion. Roc curve showed that hemoglobin levels below 12.2 g/dL, Kt/V lower than 1.9 and phase angle lower than 4.5° were the best cutoffs to predict pericardial effusion. Four patients showed these three parameters in the unfavorable range, and all these four patients presented pericardial effusion. The other patient with pericardial effusion had two of these parameters reduced. These findings corroborate the hypothesis that uremia plays a significant role in the pathogenesis of dialysis-associated pericardial effusion.

Human hair follicles contain two forms of ATP‐ sensitive potassium channels, only one of which is sensitive to minoxidil

Hair disorders cause psychological distress but are generally poorly controlled; more effective treatments are required. Despite the long-standing use of minoxidil for balding, its mechanism is unclear; suggestions include action on vasculature or follicle cells. Similar drugs also stimulate hair, implicating ATP-sensitive potassium (K(ATP)) channels. To investigate whether K(ATP) channels are present in human follicles, we used organ culture, molecular biological, and immunohistological approaches. Minoxidil and tolbutamide, a K(ATP) channel blocker, opposed each other's effects on the growing phase (anagen) of scalp follicles cultured in media with and without insulin. Reverse transcriptase-polymerase chain reaction identified K(ATP) channel component gene expression including regulatory sulfonylurea receptors (SUR) SUR1 and SUR2B but not SUR2A and pore-forming subunits (Kir) Kir6.1 and Kir6.2. When hair bulb tissues were examined separately, epithelial matrix expressed SUR1 and Kir6.2, whereas both dermal papilla and sheath exhibited SUR2B and Kir6.1. Immunohistochemistry demonstrated similar protein distributions. Thus, human follicles respond biologically to K(ATP) channel regulators in culture and express genes and proteins for two K(ATP) channels, Kir6.2/SUR1 and Kir6.1/SUR2B; minoxidil only stimulates SUR2 channels. These findings indicate that human follicular dermal papillae contain K(ATP) channels that can respond to minoxidil and that tolbutamide may suppress hair growth clinically; novel drugs designed specifically for these channels could treat hair disorders.

Long Hair Grafts: 20 Years of Experience

Twenty years ago, we set out the technique of long hair grafting based on a logical approach supported by repetitive observations and the discovery of new surgical techniques. This technique was developed in combination with the use of peri-operative use of minoxidil. A study was conducted on 16