Unlocking the Mane Potential: Oral vs. Topical Minoxidil in Female Pattern Hair Loss

Original Article: Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: a randomized clinical trial

What are the key takeaways of this article?

To date, the only Food and Drug Administration-approved drug approved for female pattern hair loss (FPHL) is topical minoxidil. Topical minoxidil is typically used in a 5% solution and can be used in both men and women. However, this treatment is commonly terminated early by patients due to changes in hair texture, perceived inefficacy, or adverse effects. Recently, the use of oral minoxidil has increased in clinical practice. As such, this study is the first to compare the efficacy of oral vs. topical minoxidil.

This randomized, open comparative study followed 50 women aged 18-65 over 24 weeks to compare the efficacy between 5% topical minoxidil and 1mg oral minoxidil. The comparison was made using TichoLAB Hair-to-Hair matching technology with a primary outcome of change in total parietal hair density, while the secondary outcomes included change in terminal hair density, quality of life (Women's Androgenic Alopecia Quality of Life Questionnaire / Sinclair hair shedding score), and global photographic evaluation.

The study found that total hair density increased by 12% in women taking oral minoxidil in comparison to 7.2% in women taking topical treatment. However, this finding had a non-significant difference. Oral minoxidil also resulted in less shedding in comparison to topical minoxidil. Additionally, differences in adverse effects were seen between groups. The topical group had an adverse effect of pruritus in 19% of participants, while the oral group saw pretibial edema in 4% of participants. Hypertrichosis was seen in 27% of oral participants versus 4% of topical participants. There was no significant difference in mean blood pressure between groups and no participants experienced hypotension. This finding is important as oral minoxidil is used as an anti-hypertensive treatment. All adverse effects were reported to be well-tolerated, and no participants dropped out of the study as a result of adverse effects.

While there was no significant difference in hair density outcomes between oral and topical minoxidil, this study concludes that the decrease in hair shedding with oral minoxidil suggests its potential superiority in treating telogen effluvium. Additionally, oral minoxidil can serve as an alternative for patients who experience adverse effects or have poor compliance with topical treatment. It is important to note that the authors recommend conducting larger population studies to further explore potential differences in density outcomes.

Overall, this study provides valuable information for healthcare professionals and patients in tailoring treatment options for FPHL based on individual tolerability and medical comorbidities.

Publication Date: September 24th, 2023

Reference: Ramos PM, Sinclair RD, Kasprzak M, Miot HA. Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: a randomized clinical trial. Journal of the American Academy of Dermatology. 2020 Jan 1;82(1):252-3.

Summary By: McKenzie Van Eaton