Alopecia areata rogaine. Topical Minoxidil: An Effective Treatment for Alopecia Areata

25.06.202112.07.2023 by alexxlab

What is the efficacy of topical minoxidil in treating alopecia areata? How does the concentration of minoxidil affect the response rate? What are the potential side effects and considerations for using topical minoxidil for alopecia areata?

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Topical Minoxidil: An Effective Treatment for Alopecia Areata

Alopecia areata is an autoimmune disorder that can lead to patchy or widespread hair loss. While the condition can be challenging to treat, research has shown that topical minoxidil can be an effective option for many patients. In this comprehensive review, we will explore the use of topical minoxidil in the treatment of alopecia areata, including the impact of different concentrations, potential side effects, and other key considerations.

Dose-Dependent Response to Topical Minoxidil

A clinical trial published in the Journal of the American Academy of Dermatology in 1987 examined the use of topical minoxidil in the treatment of alopecia areata. The study compared the efficacy of 1% and 5% minoxidil solutions, involving a total of 66 patients. The results demonstrated a clear dose-response effect, with 5% minoxidil showing a significantly higher response rate compared to 1% minoxidil.

Among patients with extensive scalp hair loss (75% or greater), the response rate, defined as terminal hair regrowth, was 38% with 1% minoxidil and 81% with 5% minoxidil. These findings suggest that the higher concentration of 5% minoxidil is more likely to elicit cosmetically acceptable regrowth in patients with patchy alopecia areata.

Occlusion for Maximum Results

The study also found that occlusion of the treated area appears to be necessary to achieve and maintain maximum results with topical minoxidil. Occlusion helps to enhance the absorption and effectiveness of the medication, leading to better hair regrowth outcomes.

Predictors of Response

The researchers noted that nonresponders were most likely to be found among those with the most extensive scalp hair loss. However, they did not identify any other clinical features that correlated with the response to treatment. Interestingly, a finding of increased T cell blastogenesis (a measure of immune cell activity) before treatment may predict a positive response to topical minoxidil.

Recurrence and Side Effects

In patients with severe alopecia areata, the study found that hair loss generally recurs after treatment is stopped and may even recur during treatment. This highlights the chronic and relapsing nature of the condition, requiring ongoing management and monitoring.

Regarding safety, the researchers reported that systemic absorption of topically applied and occluded minoxidil solutions (1% and 5%) was minimal, with no clinically significant changes in blood pressure, weight, cardiovascular status, or other laboratory parameters. However, mild local irritation was observed, and a small number of patients (2 out of 66) developed allergic contact dermatitis to minoxidil.

Implications for Clinical Practice

The findings from this study suggest that topical minoxidil, particularly the 5% formulation, can be an effective treatment option for patients with alopecia areata, especially those with patchy hair loss. The use of occlusion can enhance the efficacy of the treatment. However, the potential for recurrence and the need for ongoing monitoring should be considered in the management of this chronic condition.

It is important to note that while this study provides valuable insights, the field of alopecia areata treatment is constantly evolving, and clinicians should stay informed about the latest research and guidelines to provide the most appropriate and personalized care for their patients.

Conclusion

In summary, topical minoxidil, particularly the 5% formulation, has been shown to be an effective treatment for alopecia areata, with a dose-dependent response and the potential for enhanced results with occlusion. While the treatment may not be a panacea, it can be a valuable tool in the management of this challenging condition, especially for patients with patchy hair loss. Ongoing monitoring and consideration of the potential for recurrence are important factors in the long-term care of individuals with alopecia areata.

Topical minoxidil solution (1% and 5%) in the treatment of alopecia areata

Clinical Trial

. 1987 Mar;16(3 Pt 2):745-8.

doi: 10.1016/s0190-9622(87)80003-8.

V C Fiedler-Weiss

PMID:
3549811
DOI:
10.1016/s0190-9622(87)80003-8

Clinical Trial

V C Fiedler-Weiss.

J Am Acad Dermatol.

1987 Mar.

. 1987 Mar;16(3 Pt 2):745-8.

doi: 10.1016/s0190-9622(87)80003-8.

Author

V C Fiedler-Weiss

PMID:
3549811
DOI:
10. 1016/s0190-9622(87)80003-8

Abstract

Topical minoxidil solution can induce hair regrowth in alopecia areata. A dose-response effect was demonstrated when 48 patients treated with topical 1% minoxidil were compared with 47 patients treated with topical 5% minoxidil. A total of 66 patients were enrolled, 26 of them participating in both study groups. Patients with extensive (75% or greater) scalp hair loss showed a response rate of 38%, defined as terminal hair regrowth, with 1% minoxidil versus an 81% response rate with 5% minoxidil. The current 2% formulation is most likely to elicit cosmetically acceptable regrowth in those with patchy alopecia areata. Occlusion of the treated area appears to be necessary to achieve and maintain maximum results. Nonresponders are most likely to be found among those with the most extensive scalp hair loss. No other clinical features correlate with response to treatment. However, a finding of increased T cell blastogenesis before treatment may predict response. In patients with severe alopecia areata, hair loss generally recurs after treatment is stopped and may recur during treatment. Systemic absorption of topically applied and occluded minoxidil solutions (1% and 5%) was minimal; no clinically significant changes in blood pressure, weight, cardiovascular status, electrocardiogram, electrolytes, complete blood count, or urinalysis were seen. Mild local irritation occurred, and two of the 66 patients developed allergic contact dermatitis to minoxidil, as confirmed by patch tests.

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Useful or not? — Donovan Hair Clinic

Minoxidil in Alopecia Areata

Alopecia areata (“AA” for short) is an autoimmune condition that will affect about 1. 7% of the world’s population at some point in their lives. Many patients with AA develop hair loss in round or oval shaped patches. The individual shown in the photos has a fairly typical presentation.

There are a variety of treatments for AA including topical steroids, steroid injections, diphencyprone, anthralin, prednisone, methotrexate, sulfasalazine, tofacitinib.

Minoxidil for Treating AA

I include topical minoxidil in a large proportion of the treatment plans that I recommend for my own patients. Minoxidil is a topical product that is available in both generic forms as well as popular trade names such as “Rogaine” in North America and “Regain” in part of Europe. Studies dating back to the 1980s have shown very clearly that minoxidil is beneficial in patients with alopecia areata. My personal view is that it does not usually help on its own if one were to use it as the only treatment (i.e. ‘mono therapy) but can help when added to a treatment plan that involves any of the treatment agents listed above. When I prescribe a plan that includes use of topical steroids or steroid injections, I frequently include minoxidil on the plan. Even with anthralin or DPCP, I frequently recommend my patients use minoxidil as well.

Minoxidil in AA: Clearing up the Many Myths and Misconceptions.

There are certain many myths, confusions and inaccurate information when it comes to using minoxidil for alopecia areata. Here I will review a few common myths.

Confusion 1: Do I need to use it forever? Everyone tells me I do!

The ‘rule’ that minoxidil needs to be used forever and that one will lose hair if they stop applies to the use of minoxidil for men and women with a hair loss condition known as andoagenetic alopecia (i.e. male and female balding). These so called rules do not necessary apply to alopecia areata. Once hair starts growing really well again in those with alopecia areata, it is frequently possible for many to stop the use of minoxidil and still keep their hair. OF course, minoxidil may be needed again in the future were a patch of hair loss to occur again. However, the purchase of one bottle of minoxidil does not necessarily commit one to a lifetime of use.

Confusion 2: The bottle says not to use it if I have patches of hair loss! What am I to do?

It is important to understand that minoxidil is only FDA approved for treating genetic hair loss. It has not gone through the million dollar rigours of the FDA approval process to have it formally approved for treating alopecia areata. However, we know from very good studies one the last 30-40 years that minoxidil does help patients with alopecia areata. Therefore, any such use in alopecia areata is said to be ‘off label.’ Because minoxidil is formally approved only for androgenetic alopecia the companies can not advertise that it helps other hair loss conditions. It is illegal for companies to write on their packaging that this product can be used in alopecia areata, traction alopecia, some forms of scarring alopecia. As a physician however, I can recommend it to certain patients with these conditions if I feel it will be helpful. However, the only thing that can be advertised by the companies is that it can be used in androgenetic alopecia.

Confusion 3: I’ve heard minoxidil can cause hair loss. I’m terrified to start.

It is very well known that men and women who use minoxidil for treating ‘androgenetic alopecia’ (male and female balding) can developed hair loss in the first two months of use. This is because minoxidil triggers hairs in the telogen phase to exist fairly quickly over a span of a few weeks. This phenomenon can also happen in alopecia areata but one must remember that what is actually happening in most individuals is that minoxidil is triggering older injured hairs to exist and helping to facilitate new stronger hairs to reemerge. Most of the time a patient with alopecia areata who says their hair is worsening and worries that it is the minoxidil that is causing the worsening is actually just experiencing a worsening of their disease. For these individuals the minoxidil is not causing the hair to fall out more – it is the disease itself that is causing this. This individual needs more aggressive treatment.

Confusion 4: Should I use 2 % or 5 %? Should I use minoxidil drops or the foam?

There is no ‘one answer’ for all patients. The decision on what type of minoxidil to use should be reviewed on a case by case basis. In general, if one is going to use minoxidil, they should just get the product on the scalp consistency. There are situations where I recommend the 2 % lotion and there are situations where the 5 % foam is perfect. The benefit of the older lotion is that a patient can more carefully control the dosing. Instead of using 1/2 cap of the foam, a patient using the lotion is allowed to use up to 1 mL (25 drops). This frequently allows more of the product to be spread all around the scalp. In addition, if a patient is very sensitive to the effects of minoxidil and develops headaches or dizziness and there are worries about the effects of minoxidil on the heart, I may recommend 2 % minoxidil and start with 4-6 drops and slowly work up to 25. The key is to get the product on the scalp.

Conclusion

Minoxidil has been used as therapy for treating alopecia areata for over 3 decades. Its use is off label but given its generally good safety profile, it its an important consideration. I frequently combine it with many treatments I recommend for AA.

REFERENCE

Price VH. Double-blind, placebo-controlled evaluation of topical minoxidil in extensive alopecia areata. Clinical Trial. J Am Acad Dermatol. 1987.

Alopecia areata (focal) in women and men: causes and treatment

Dermatologist (trichologist)

Saperova

Olga Ivanovna

Doctor

Make an appointment

Alopecia areata is a process of progressive hair loss on the head or other hairy areas of the skin. The considered form of pathology rarely leads to complete baldness of the patient. Foci of complete absence of hair alternate with areas of healthy hairline. The main cause of alopecia areata are stressful conditions in which adults and children are. Pathology equally often develops in men and women. The state of focal alopecia does not threaten the health of patients, but is considered by them as a pronounced cosmetic defect.

Disease etiology

The causes of alopecia areata are varied. So, girls often experience hair loss due to physiological changes in the body during pregnancy. Manifestations of pathology are possible in the postpartum period. Similarly, the condition of the hair can be affected by the oral intake of certain drugs:

retinoids;
hormonal contraceptives;
anticoagulants.

The risk group includes patients who are in permanent stress. Endocrine disorders have a significant impact on the condition of the hairline. Iron or zinc deficiency and treatment of anemia can lead to alopecia areata.

Loss of growing hair often occurs against the background of intoxication of the body with bismuth, arsenic, boric acid, salts of heavy metals. The density of the hairline can rapidly decrease when the patient undergoes radiation therapy. A significant deterioration in the condition of hair follicles is observed in persons suffering from mycoses of various origins.

Alopecia areata occurs suddenly. The foci have a rounded shape, their size can vary from 25-30 to 80-100 mm. The exact causes of the formation of geometrically verified areas of hair loss have not been established. Alopecia of this type is prone to peripheral growth, which can cause total baldness. Lesions are localized on the scalp, but can occur in the eyebrows, eyelashes, beards and mustaches. In rare cases, hyperemia appears at the site of the fallen hair.

Symptoms

Careful examination of the affected area allows you to see the mouths of the hair follicles. Peripheral growth of foci of alopecia can lead to their fusion. The edge of the “nest” contains loose hair that falls out with little impact. Their roots are devoid of pigmentation. The hair ends in a thickening in the form of a white dot. The absence of this symptom indicates that alopecia areata has stopped progressing and has passed into the stationary stage.

With a decrease in physical and emotional stress, the patient can count on restoring the previous density of the hairline in areas of baldness. The recovery period can last several years. At the first stage, thin colorless hair appears. Over time, they acquire the usual structure and pigmentation. Regression of alopecia is a reversible process, relapse can occur under the influence of the primary factor of baldness or for another reason.

Diagnosis

The diagnosis is made during the examination of the patient by a trichologist. The doctor notes a decrease in the density of the hairline and the appearance of areas of complete baldness. A mechanical test is carried out – pulling the hair shaft leads to its easy removal from the place of growth.

Identifying the causes of alopecia will allow the doctor to develop an effective course of treatment. The patient receives a referral for tests. Laboratory tests of the blood of a child or an adult will reveal a reduced number of T- and B-lymphocytes. Their deficiency is characteristic of focal alopecia, which arose against the background of psycho-emotional stress.

Microscopy of the hair shaft makes it possible to exclude mycoses from the patient’s history. Often, trichologists perform a skin biopsy on alopecia areata. Examination of the biopsy specimen under a microscope makes it possible to detect signs of systemic lupus erythematosus, sarcoidosis, or lichen planus. Spectral analysis of hair provides information about their saturation with microelements.

Treatment

Compliance with the rules of hygiene is an important aspect of the treatment of alopecia. The focal form of the pathology allows you to wash your hair daily (which is unacceptable with seborrheic lesions of the scalp). Patients should use neutral shampoos that do not contain emollients or other complex ingredients.

Individuals suffering from alopecia areata are prescribed oral vitamins and minerals. This measure is designed to normalize metabolic processes in the body of a child or adult and stimulate hair growth.

Diet has a significant impact on the success of treatment. The diet should contain foods high in zinc. Patients are advised to regularly consume liver, fish, grains, mushrooms, fresh vegetables, orange juice. For the period of treatment it is necessary to give up coffee, alcohol and cigarettes. Their absence will allow the autonomic nervous system to return to normal. The presence of ethanol metabolites in the patient’s body can reduce the effectiveness of drug therapy.

Stimulation of hair growth in alopecia areata is carried out with the help of furocoumarin preparations, a list of which is contained in the clinical recommendations of the Ministry of Health. The schedule for the use of these funds is determined by the trichologist based on the results of the tests and the clinical picture of the pathology. The child or adult is scheduled for regular visits for examinations to assess progress in the treatment of patchy alopecia.

Forecast

Localized alopecia areata can be successfully treated. The hairline is restored within 12-24 months after the start of therapy. The total form of alopecia areata is not always amenable to conservative treatment due to massive damage to the hair follicles. In this case, patients are offered hair transplantation.

Questions and answers

Is it possible to use traditional medicine to treat baldness?

The use of alternative tactics for the treatment of alopecia can adversely affect the condition of the intact scalp. Alternative methods do not have a proven clinical effect.

At what age can alopecia areata appear?

Pathology can develop in patients of any age. Stress, lack of vitamins and minerals, hormonal changes in the body of a child or an adult become the main causes of alopecia areata. The largest number of clinically recorded cases of pathology falls on the age group of 25-40 years.

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