Does inflammation in the scalp help minoxidil work better or worse?

How does inflammation affect how minoxidil helps over time?

I’ve selected this question below for this week’s question of the week. It allows us to review some concepts in treatment of androgenetic alopecia with minoxidil and the relationship to inflammation.

Question

I have androgenetic alopecia and my scalp is red at time as I have seborrheic dermatitis or some say psoriasis. I have heard that inflammation in the scalp may mean minoxidil works less well and other say it will work better.

What is the correct answer?

Answer

This is such a great question. The full answer as to whether inflammation causes minoxidil to work better or worse really comes down to what is causing the inflammation. There are 100 causes of inflammation in the scalp!!!! Some causes might make it work better and some might cause it to work less well.

As we tackle this subject, it’s important to keep in mind that few studies have actually been done.

Inflammation and fibrosis are known to affect responses to minoxidil. In 1993, Dr Whiting showed that patients with significant perifollicular inflammation and fibrosis have poorer responses to topical minoxidil. We don’t routinely evaluate inflammation in the scalp with males and females with androgenetic alopecia in deciding whether minoxidil will work or not. However, this 1993 study reminds us that it’s relevant.

There are other situations whereby inflammation probably makes the minoxidil work better. We sometimes add retinoic acid to minoxidil for example to make it more irritating and therefore get into the scalp better. Here is an example where we think inflammation helps minoxidil work better rather than worse. It’s not entirely clear if inflammatory states like seborrheic dermatitis, psoriasis, lupus, contact dermatitis are associated with better responses to minoxidil or not. The companies that make minoxidil warn users not to use if they have these sorts of inflammatory conditions. That is due to concern it might get into the scalp better.

All in all, there may be some inflammatory states where minoxidil works better and gets into the scalp more efficiently. This may also be associated with a greater chance of side effects like hair on the face or body, palpitations, headaches, etc. Be sure to discuss your specific situation with your dermatologist or hair specialist. If may not be a strict contraindication to use minoxidil if there is inflammation on the scalp but you will likely need a bit closer monitoring to ensure you are not developing worsening inflammation and not getting side effects from the treatment.