Should Oral Minoxidil Users Also be using Topical Minoxidil?

New Study suggests Topical Minoxidil Provides No Benefit If Patients are Also Using Oral Minoxidil

Topical minoxidil is FDA approved for treating androgenetic alopecia and is often used off label for treating a variety of other hair loss issues such as telogen effluvium, alopecia areata and scarring alopecia. Oral minoxidil is increasingly used worldwide for treating hair loss problems and can be used alone or with topical minoxidil.

Klein et al, 2022

Authors of a new study aims to compare therapeutic outcomes of patients treated with LDOM and topical minoxidil compared to oral minoxidil alone. Trichoscopic measurements were done with Folliscope.

Results

There were 117 patients in the study. 59% were female and 41% were male. 68 % had androgenetic alopecia and 28 % had telogen effluvium. Of the 117 patients treated with LDOM, 60 % also received topical 5% minoxidil twice daily (combination therapy). Of the oral minoxidil users, 18 % used 0.625 mg , 54% used 1.25 mg, 27 % used 2.5 mg and , 1 % used 5 mg.

Patients were assessed at a 3-6 month follow-up and a 6-13 month follow-up. Patients using low dose oral minoxidil and patients using combination therapy all had an increase in hair density and hair caliber. However, there was no statistical difference in the improvements in hair density or caliber between the groups.

Conclusion and Discussion

The authors conclude in this small study that combination therapy with topical minoxidil and oral minoxidil does not provide additional benefit over oral minoxidil alone.

In other words, data here seemed to indicate that patients using an average of 1.25 mg of oral minoxidil would not be expected to get more benefit from also adding 5% topical minoxidil solution twice daily to their plan.

This is a small study which has some limitations. They include patients with alopecia areata, telogen effluvium and androgenetic alopecia grouped together so it’s hard to tease apart differences according to type of hair loss. In addition, most patients were using minoxidil solution rather than foam so these data may or may not be generalizable to the foam. We would expect that it should be but it’s interesting just how few patients here were using the more population minoxidil foam. Males and females could have differences and this study included both males and females.

We also don’t know if patients using really small doses like 0.25 mg or 0.625 mg are likely to benefit from also using the foam. Many women use 0.25 to 1.25 mg and some use 0.625 mg. This study had only 18 % of patients on the 0.625 mg dose so it’s difficulty to really know if topical minoxidil could benefit these patients.

Finally, we don’t really know if removing topical minoxidil in someone on longstanding combo therapy is really such as good idea. This study would suggest it should not be a problem for most patients but really we don’t know this and this study was not set up to assess this.

This study is interesting and sets the stage for further studies. I think that focused studies in one disease model (androgenetic alopecia, CTE) and in males or females individually will provide us with the clearest information.

REFERENCE

Klein E et al. Comparing combination low-dose oral minoxidil and topical minoxidil with oral minoxidil alone for the treatment of non-scarring alopecia; a retrospective chart review. J Cosmet Dermatol. 2022 Jun 1.