Topical Minoxidil: Not Great for Patchy AA, but not too Bad Either!

Topical Minoxidil Inferior to Betamethasone dipropionate in Treatment of Patchy Alopecia Areata

I enjoyed reading a study from Pakistan comparing topical betamethasone dipropionate and topical minoxidil in the treatment of patchy alopecia (less than 50% loess). This non-randomized study involved 100 patients—50 received topical betamethasone dipropionate twice daily, and 50 received topical minoxidil twice daily. The study lasted four weeks.

The authors showed that topical betamethasone dipropionate was superior to topical minoxidil in helping people regrow hair. 74 % of patients in the betamethasone dipropionate group achieved a 50 % or more improvement in their hair, compared to 42% of patients in the minoxidil-only group. However, the point that must not be missed in this study is that topical minoxidil still helped!

Conclusion

The study's conclusion is, of course, that topical betamethasone dipropionate twice daily is better than topical minoxidil 5% twice daily for patchy alopecia areata.

What I liked in this study is something that is ignored and pushed aside - that topical minoxidil still performed reasonably well! It was not as good as topical betamethasone dipropionate, but it had a respectable performance.

Let’s face it—topical betamethasone dipropionate and topical minoxidil are both pretty safe over a short period, like four weeks. But you can’t keep rubbing on betamethasone dipropionate forever. Prolonged use can thin the skin and even contribute to side effects if too much is used. One must take breaks every now and then if betamethasone dipropionate is going to be used.

Topical minoxidil, on the other hand, is reasonably safe for continued use. It does not thin the skin, and it is widely available and does not require a prescription in many countries.

One must always remember that topical minoxidil still has a role in the alopecia areata treatment toolbox!

Here are my first line, second line and third line options for the treatment of alopecia areata

REFERENCES

Aslam S et al. Comparison of Efficacy of Topical Betamethasone Dipropionate and Topical Minoxidil in Patients With Alopecia Areata. Cureus . 2024 Mar 16;16(3):e56282. doi: 10.7759/cureus.56282. eCollection 2024 Mar.