Oral and Topical Minoxidil: Efficacy in Male Androgenetic Alopecia

Original Article: Oral Minoxidil vs Topical Minoxidil for Male Androgenetic Alopecia: A Randomized Clinical Trial

What are the key takeaways of this article?

Androgenetic alopecia (AGA), commonly known as male pattern baldness, significantly impacts self-esteem and quality of life. Currently, the main therapeutic options for AGA include both oral finasteride and topical minoxidil. However, these treatments are not without limitations. These may include potential adverse sexual effects from finasteride and issues related to the topical application of minoxidil that may deter patient adherence. A recent study by Penha and colleagues investigates the potential of low-dose oral minoxidil as an alternative to the traditional topical formulation in the treatment of male AGA.

This double-blind, placebo-controlled randomized clinical trial in Brazil aimed to compare the efficacy, safety, and tolerability of daily oral minoxidil (5 mg) versus twice-daily topical minoxidil (5%). The study included 90 male participants aged 18 to 55 years, diagnosed with AGA using the Norwood-Hamilton scale classifications of 3V, 4V, or 5V.

Participants were randomly assigned to one of two groups: one receiving oral minoxidil and a topical placebo, and the other receiving topical minoxidil and an oral placebo. The primary outcomes measured were changes in terminal hair density and total hair density at the frontal and vertex regions of the scalp over 24 weeks. Secondary outcomes included photographic evaluations and assessments of adverse effects, blood pressure, and heart rate.

Results from the trial revealed no significant difference between the two groups in terms of increase in terminal and total hair density at the frontal area. However, for the vertex area, oral minoxidil showed a superior outcome in photographic analysis, indicating a possible area-specific efficacy. Both treatments were well tolerated, with hypertrichosis and headache being the most reported adverse effects in the oral minoxidil group. The topical group reported more local adverse effects such as itching and eczema.

Further studies with larger sample sizes and diverse populations are recommended to fully establish the efficacy profiles of both forms of minoxidil and potentially explore synergistic effects with other treatments.

Publication Date: May 26th, 2024

Reference: Penha MA, Miot HA, Kasprzak M, Müller Ramos P. Oral Minoxidil vs Topical Minoxidil for Male Androgenetic Alopecia: A Randomized Clinical Trial. JAMA Dermatol. Published online April 10, 2024. doi:10.1001/jamadermatol.2024.0284

Summary By: Parsa Abdi, Memorial University