Clinical efficacy and safety of low‐dose oral minoxidil versus topical solution in the improvement of androgenetic alopecia: A randomized controlled trial

Abstract

BackgroundTopical minoxidil is the recommended first‐line pharmacologic treatment for male and female pattern hair loss. However, low‐dose oral minoxidil has been used off‐label with good clinical efficacy and safety.AimTo compare the effectiveness and safety of topical minoxidil as a first‐choice treatment of androgenetic alopecia versus 1 mg daily oral minoxidil.MethodSixty‐five AGA patients were randomly allocated to receive either 5% topical solution or 1 mg/day oral minoxidil for 6 months. Treatment efficacy was evaluated by measuring hair diameter, photographic assessment, and patient self‐assessment questionnaires. The safety of treatment was checked through history taking and physical examination.ResultsBoth topical and oral minoxidil groups showed significant improvement in hair diameter after 6 months of treatment (p < 0.001). However, there was no significant difference between the two groups. The photographic assessment demonstrated a significant improvement in hair density in the topical minoxidil group in all marked points located at 12 cm (p = 0.025), 16 cm (p = 0.034), and 24 cm (p = 0.014) distance from the glabella but not in the oral minoxidil group. Nevertheless, the difference between the two groups was not significant. In each group, over 60% of patients expressed satisfaction with their treatments, and no significant difference was detected between the two groups.ConclusionAlthough topical minoxidil has a better overall therapeutic effect than 1 mg oral minoxidil, the difference between the two groups was not significant. Therefore, 1 mg oral minoxidil may be as effective and safe as standard topical minoxidil in female and male pattern hair loss.

Topical Minoxidil Overdose in a Young Man With Androgenetic Alopecia: A Case Report

“…The number of case reports of topically applied minoxidil intoxication or systemic side effects is much smaller than the number of reports of minoxidil poisoning after oral intake. At the moment, the possibility of using tablet forms of minoxidil to treat various types of alopecia in men and women is being studied [ 8 - 10 ]. Nevertheless, minoxidil causes severe toxicity when sufficiently ingested [ 11 - 13 ].…”

What's Old Is New Again

“…Patients should be made aware of the potential risks and black box warning associated with this medication. Comparison studies between TM 5% and LDOM showing similar efficacy rates with consistent use should be reviewed with patients (Asilian et al, 2023; Ramos et al, 2020). Despite this information, patients may prefer LDOM and, according to the literature, are likely to report significant benefits from taking this medication (Sharma et al, 2020).…”