Topical Treatments: Unless the Treatment is Amazing People Generally Dislike Topical Treatments
There is a major push to develop better and better and safer and safer treatments for hair loss. There is a move from using oral treatments (ie oral finasteride) to using topical ones (ie topical finasteride). At the same time, there is ongoing recognition that many patients don’t like topical treatments. Critics can relax - of course some people don’t mind topical treatments. Yes, there are countless patients the apply topical treatments every day. Yes, not a day goes by that a patient doesn’t say to me how they are using their topical product “religiously.” But most people don’t like them. The strategists and big thinkers of the hair world understand this. Most don’t.
Men, Minoxidil and the Mapar Study: Do most men use minoxidil as they should?
I’d like to introduce you to a study that is often forgotten. I think it’s as much a study of behavioural psychology as it is a study of hair loss treatment.
A 2007 study by Mapar examined the proportion of men that stopped using minoxidil. As we go about reviewing this study it’s important to keep in mind that minoxidil doesn’t do all that much for about 75 % of men. It helps 25 % to various degrees and the rest aren’t helped all that much. So, in any study looking at use and disuse of minoxidil, we expect a good amount to eventually stop using - but we also expect a good proportion to carry on!
Mapar studied 1495 men aged 20-40 years who started treatment with 5% topical minoxidil solution. Remarkably, almost all the patients gradually avoided continuing the treatment. Only in a few patients was the cessation of medication due to adverse effects. The causes of discontinuation in the majority of patients were the low effect of medication and an aversion to this topical treatment method.
There are flaws to any study and granted this one has them too. But this study has important lessons. Humans are more likely to apply topical treatments if the treatment works fast and has good effect. We’re less likely to commit to a topical plan if outcomes are slow and mediocre.
It would be a mistake to conclude from this study that minoxidil has no role in male balding. Not at all. The take home message form this study is that most men left to their own will - are going to stop using. It’s the role of the specialist to help manage expectations and to encourage use for the appropriate amount of time to determine if it’s working or not.
Mapar et al. Is topical minoxidil solution effective on androgenetic alopecia in routine daily practice?J Dermatolog Treat. 2007;18(5):268-70.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887