Traction alopecia: Oral Minoxidil is an Important Consideration when Topical Does not Work

Oral Minoxidil for Traction Alopecia

Several studies in the last have reported the benefits of topical and oral minoxidil in treating traction alopecia. Let’s take a look at an important prior study examining the role of oral minoxidil and an interesting new one.

Beach 2018

In 2018, Dr Beach described 4 female patients with traction alopecia who used oral minoxidil at 1.25 mg. The patients with traction alopecia in this study were young (25-32). None had feelings of blood pressure with minoxidil nor increased shedding. One had increased hair on the face (hypertrichosis). 3 of the 4 patients were able to continue the medication, but one stopped because of an aversion to using pills.

Kim and Craiglow 2022

In a new report, Kim and Craiglow report a 31 year old female with traction alopecia.

The patient had a history of wearing hair in tight hairstyles in the past - but had not been doing so for several years prior to presentation. She was presently using chemical relaxers. She had been treated previously with topical corticosteroids and 5% topical minoxidil without any improvement.

The patient was started on oral minoxidil 1.25 mg daily. The patient also used fluocinonide 0.05% topical solution 2-3 times weekly for the first 2 months. After 6 months of using the oral minoxidil, there was notable regrowth of hair, and minoxidil was increased to 1.25 mg twice daily. After an additional five months of the treatment (11 month total), there was continued regrowth of hair on the bilateral frontotemporal scalp The patient continued to use chemical relaxers throughout this time.

Side effects experienced by the patient were limited to mild hypertrichosis of the bilateral cheeks. The patient otherwise tolerated the 2.5 mg dose really well.

Before and After photos in a 31 year old patient using oral minoxidil 2.5 mg. SOURCE: Kim and Craiglow. Treatment of traction alopecia with oral minoxidil. JAAD Case Rep. 2022 Apr 1;23:112-113. Photos used with creative commons license.

Conclusion

This is a nice report. Traction alopecia responds quite well to oral minoxidil (and sometimes topical minoxidil too!).

I liked this study for a few reasons:

POINT 1 - Topical steroids are very much a part of the treatment of traction alopecia

POINT 2 - Oral minoxidil can still help some of those who don’t seem to benefit after using topical minoxidil

POINT 3 - Oral minoxidil is best started at 0.625 mg or 1.25 mg in women before increase to higher doses. Not all women tolerated doses above 1.25 mg but fortunately many do.

POINT 4 - Hypertrichosis is a common side effect of oral minoxidil but does not necessarily prompt most women to stop the drug.

All in all, this report reminds us that both topical and oral minoxidil are on the list of treatment options for traction alopecia. Patients who do not show improvement with topical minoxidil could still potentially benefit from oral minoxidil.

REFERENCE

Kim and Craiglow. Treatment of traction alopecia with oral minoxidil. JAAD Case Rep. 2022 Apr 1;23:112-113.
Beach RA. Case series of oral minoxidil for androgenetic and traction alopecia: Tolerability & the five C's of oral therapy. Dermatol Ther. 2018 Nov;31(6):e12707.