I'm itchy from minoxidil. What should I do?

Itching from minoxidil (Rogaine, Regaine and generics) is not uncommon. For some individuals, the itching comes from irritation from an ingredient in commercial formulations of the minoxidil solution known as propylene glycol. Many, many formulations have propylene glycol. (The minoxidil foam does not contain propylene glycol). For others, the itching is from an exacerbation of underlying seborrheic dermatitis. For others there is a true allergy to minoxidil that is responsible for the itching. Anyone concerned about their itching should see a physician for guidance.

Tips for Dealing With Itching From Minoxidil 

Dealing with itching from use of minoxidil can be frustrating. A methodical approach can sometimes allow patients to solve or reduce their itching. Generally, my tips to my own patients are as follows:

1. A little bit of itching is seldom a major worry.  If it is minor or itchy events are not frequent, it may not be necessary to address the issue.

2. I often have patients with minoxidil-related itching to shampoo daily and add ketoconazole or zinc pyrithione or selenium sulphide based shampoos to their routines. Many will use these shampoos for 2 minutes in duration 3-4 times per week for 3 weeks then go down to twice weekly after that. Sometimes I may even go up to 3-5 minutes but it depends on the specific situation. In some cases, I find it particularly helpful to use these shampoos daily for a few weeks and simply alternate them. For example, Monday one might use zinc pyrithione and Tuesday selenium sulphide and Wednesday ketoconazole and then repeat. In this protocol of using them daily, I advise to start with 60 seconds rather than 2 - 5 minutes. as it tends to be better tolerated.

3. If the itch persists, I advise patients to try to find the Minxoxidil foam formulation (if not using already) or I write a prescription for minoxidil compounded in glycerin, water and ethanol instead. The foam formulation as mentioned lacks propylene glycol and is less likely to cause itching.

4. If still an issue and we really want to use it we may add a topical steroid in the picture. Either compounded with the minoxidil or as a shampoo once weekly.

5. Oral minoxidil 1 mg will be an option for some of my patients.

6. Going down to 2 % instead of 5% can still work well for many as is less likely to cause itching. The 5 % lotion has more propylene glycol and is therefore  more likely to cause itching.  For men, 2 % is not quite as good as the 5 % but it is a close second place. For women, the use of 2 % and 5 % are fairly equal according to all present studies that have been done.

Conclusion

All in all, there are many causes of itching following use of minoxidil. A methodical approach will frequently help solve the issue - but not always! Consultation with an expert is helpful.