Low-dose oral minoxidil shows similar results to topical treatment in alopecia
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Key takeaways:
- Low-dose oral minoxidil and topical minoxidil had similar hair regrowth results in androgenetic alopecia.
- The oral option showed slightly better photographic improvement in the vortex area.
Low-dose oral minoxidil was similarly efficacious as the drug’s topical version in male androgenetic alopecia, according to a study.
“Androgenetic alopecia (AGA) is the main cause of hair loss among men. It occurs due to progressive miniaturization of the hair follicles and shortening of the anagen phase,” Mariana Alvares Penha, MD, MSc, of the department of dermatology at the Faculty of Medicine of Botucatu in São Paulo State University, and colleagues wrote. “There has been increased interest worldwide in low-dose oral minoxidil, 0.25 mg to 5 mg per day, as an alternative therapy for AGA.”
The double-blind, placebo-controlled randomized clinical trial included 90 male patients with AGA, of which 68 completed the study. Patients were randomly assigned 1:1 to receive once-daily oral minoxidil 5 mg with twice-daily topical placebo solution (n = 33) or twice-daily topical minoxidil 5% 1 mL with once-daily oral placebo (n = 35).
At baseline and at week 24 terminal hairs with a diameter of at least 0.06 mm in the frontal and vertex regions were blindly counted to determine terminal hair density.
The mean change from baseline in both terminal and total hair density were similar in the two groups at 24 weeks.
Between the two groups, mean change in the frontal area was 3.1 (95% CI, –18.2 to 21.5) hairs per cm2 for terminal hair density and 2.6 (95% CI, –10.3 to 15.8) hairs per cm2 for total hair density. In the vertex area, the mean change was 23.4 (95% CI, –0.3 to 43) hairs per cm2 for terminal density and 5.5 (95% CI, –12.5 to 23.5) hairs per cm2 for total hair density.
In the oral minoxidil group, the terminal hair density increase was 27.1% (95% CI, 6.5%-47.8%) higher in the vertex area and 13.1% (95% CI, –11.5% to 37.5%) higher in the frontal scalp vs. the topical group. Further, total hair density was 2.1% (95% CI, –8.1% to 12.3%) higher in the oral minoxidil group in the vertex area and 0.2% (95% CI, –8.4% to 8%) decreased in the frontal area vs. topical group.
Three blinded dermatologists found 20 (60%) individuals in the oral minoxidil group and 17 (48%) in the topical minoxidil group to have clinical improvement in the frontal area, with no significant difference between the two treatment groups. In the vertex area, more patients in the oral treatment group (n = 23; 70% vs. n = 16; 46%) had clinical improvement.
Adverse events were mild, with one patient in the oral group stopping medication due to headache. The most common adverse event in both groups was hypertrichosis (oral, n = 22; 49% vs. topical, n = 11; 25%).
“Oral minoxidil 5 mg once per day did not demonstrate superiority over topical minoxidil 5% twice per day in the treatment of male AGA after 24 weeks,” the authors wrote. “Nevertheless, the overall photographic improvement in the vertex was superior in the
oral minoxidil group. Low-dose oral minoxidil has shown to be well tolerated and, therefore, is an option for patients who prefer oral therapy or are intolerant to topical treatment.”
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