Oral Minoxidil For Chronic Shedding
Chronic telogen effluvium is a type of hair shedding condition. Patients report high levels of daily hair shedding that seems to wax and wane. Some days and weeks are associated with high levels of shedding whereas other weeks seem less. This is extremely frustrating for patients as there seems to be no clear reason for any of the shedding patterns. Most patients with true CTE are between 30-60 and have normal blood tests. A proportion of patients not only have shedding but unusual scalp symptoms, which collectively fit under the umbrella term of trichodynia.
The treatments for CTE are limited. A number of things can be tried but none are consistently effective, Common treatments including topical minoxidil, laser, vitamins, supplements, and platelet rich plasma.
In 2017, Dr Rod Sinclair and colleague Dr Perera set out to examine the benefits of oral minoxidil in the treatment of CTE. In total , 36 female patients (mean age 46.9) with CTE were treated with oral minoxidil (range, 0.25-2.5 mg) daily for 6 months. Oral minoxidil was found to reduce shedding. 5 of the 36 women who noted trichodynia (scalp pain) at baseline had improvement at 3 months.
Although oral minoxidil is a blood pressure medication, mean blood pressure change was only 0.5 mmHg systolic and 2.1 mmHg diastolic. 2 patients had dizziness that improved over time even with continuation of treatment. 13 (36 %) women developed increased hair on the face. 1 patient developed swelling of the ankles. Interestingly, all 36 women completed the 12 months study.
This is an interesting study. The treatment of CTE tends to be frustrating for doctors and patients alike. Some patients respond to standard treatments but certainly not all. This study offers hope that oral minoxidil could also be added to the list of treatments for this frustrating shedding condition. Oral minoxidil does appear safe and we have been using it in clinic for some time. The most common side effects is the increased hair on the face (especially upper lip) and body that some patients get. Dizziness, headaches, hives, ankle swelling are among the other side effects.
The most common side effect in practice is increased hair on the upper lip in 25- 35 % of women. Other less common side effects are typically headaches, ankle swelling, hives. Surprisingly, shedding does not tend to be very common when starting
Perera E and Sinclair R. Treatment of chronic telogen effluvium with oral minoxidil: A retrospective study. F1000Res. 2017.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299