Alopecia areata rogaine. Topical Minoxidil for Alopecia Areata Treatment: Efficacy and Considerations

26.06.202112.07.2023 by alexxlab

How effective is topical minoxidil for treating alopecia areata. What dosage of minoxidil shows the best results for hair regrowth. Are there any side effects or limitations to using minoxidil for alopecia areata.

Содержание

Understanding Alopecia Areata and Minoxidil Treatment

Alopecia areata is an autoimmune condition that causes hair loss in patches on the scalp and other parts of the body. Topical minoxidil, a medication originally developed to treat high blood pressure, has shown promise in treating this condition. But how exactly does it work, and what should patients know before starting treatment?

Minoxidil’s mechanism of action in promoting hair regrowth is not fully understood. However, it is believed to work by:

Increasing blood flow to hair follicles
Prolonging the anagen (growth) phase of the hair cycle
Stimulating dormant follicles to produce new hair growth

Dosage and Efficacy: Comparing 1% vs 5% Minoxidil Solutions

A clinical trial conducted by V.C. Fiedler-Weiss compared the efficacy of 1% and 5% topical minoxidil solutions in treating alopecia areata. The study involved 95 patients, with some participating in both treatment groups. What were the key findings of this research?

The results demonstrated a clear dose-response effect:

1% minoxidil solution: 38% response rate in patients with extensive scalp hair loss (75% or greater)
5% minoxidil solution: 81% response rate in patients with extensive scalp hair loss

These findings suggest that higher concentrations of minoxidil may be more effective in promoting hair regrowth, particularly in cases of severe alopecia areata. However, it’s important to note that the currently available over-the-counter formulation is 2%, which falls between the concentrations tested in this study.

Factors Influencing Treatment Success

While minoxidil shows promise in treating alopecia areata, not all patients respond equally to the treatment. What factors may influence the likelihood of success?

The study identified several key factors:

Extent of hair loss: Patients with more extensive hair loss were less likely to respond to treatment
Occlusion: Covering the treated area appears necessary for achieving and maintaining maximum results
T cell blastogenesis: Increased T cell activity before treatment may predict a better response

It’s important for patients and healthcare providers to consider these factors when deciding on a treatment plan and setting realistic expectations for outcomes.

Treatment Duration and Maintenance

One crucial aspect of minoxidil treatment for alopecia areata is understanding the long-term effects and maintenance requirements. How long do the benefits of minoxidil last, and what happens when treatment is discontinued?

The study found that:

Hair loss often recurs after treatment is stopped, particularly in severe cases
Some patients may experience hair loss recurrence even during ongoing treatment
Continuous application may be necessary to maintain results

These findings highlight the importance of patient education and setting realistic expectations about the long-term commitment required for minoxidil treatment in alopecia areata cases.

Safety Profile and Systemic Absorption

When considering any topical treatment, it’s crucial to understand the potential for systemic absorption and associated side effects. How safe is topical minoxidil when used for alopecia areata treatment?

The study reported minimal systemic absorption of topically applied and occluded minoxidil solutions (1% and 5%). No clinically significant changes were observed in:

Blood pressure
Weight
Cardiovascular status
Electrocardiogram readings
Electrolyte levels
Complete blood count
Urinalysis results

This safety profile suggests that topical minoxidil, when used as directed, poses minimal risk of systemic side effects. However, it’s always important for patients to consult with their healthcare provider before starting any new treatment.

Potential Side Effects and Allergic Reactions

While the systemic safety profile of topical minoxidil appears favorable, are there any local side effects or reactions that patients should be aware of?

The study reported two main types of adverse reactions:

Mild local irritation: This was relatively common but generally not severe enough to discontinue treatment
Allergic contact dermatitis: Two out of 66 patients (approximately 3%) developed this condition, confirmed by patch tests

These findings suggest that while most patients tolerate minoxidil well, a small percentage may experience allergic reactions. Patients should be advised to monitor for signs of irritation or allergic responses and report any concerns to their healthcare provider promptly.

Comparing Minoxidil to Other Alopecia Areata Treatments

While this study focuses on minoxidil, it’s important to consider how it compares to other treatments for alopecia areata. What other options are available, and how do they stack up against minoxidil?

Other common treatments for alopecia areata include:

Topical corticosteroids: Often used as a first-line treatment, especially for small patches
Intralesional corticosteroid injections: Can be effective for larger patches but may cause skin atrophy
Topical immunotherapy: Used for extensive cases, but can cause severe irritation
Systemic treatments: Such as oral corticosteroids or immunosuppressants, reserved for severe cases due to potential side effects

Compared to these options, minoxidil offers several advantages:

Non-invasive application
Relatively few side effects
Can be used long-term without the risks associated with prolonged steroid use

However, its efficacy may be lower than some more aggressive treatments, particularly for severe cases.

Future Directions in Alopecia Areata Treatment

As research in alopecia areata treatment continues to evolve, what new developments or areas of study might we expect to see in the future?

Emerging areas of research include:

JAK inhibitors: These oral medications have shown promise in clinical trials for severe alopecia areata
Combination therapies: Exploring the potential of combining minoxidil with other treatments for enhanced efficacy
Personalized medicine approaches: Using genetic and biomarker data to predict treatment response and tailor therapies
Novel delivery systems: Investigating methods to improve the absorption and efficacy of topical treatments

These advancements may lead to more effective and personalized treatment options for alopecia areata patients in the future, potentially improving upon the results seen with minoxidil alone.

Practical Considerations for Minoxidil Use in Alopecia Areata

For patients considering or currently using minoxidil for alopecia areata, there are several practical aspects to keep in mind:

Application technique: Ensure even coverage of the affected areas and follow instructions carefully
Consistency: Regular, daily application is crucial for maintaining results
Patience: Hair regrowth can take several months to become noticeable
Monitoring: Keep track of progress and any side effects to discuss with your healthcare provider
Complementary care: Consider using gentle hair care products and avoiding harsh treatments that could exacerbate hair loss

By following these guidelines, patients can maximize the potential benefits of minoxidil treatment while minimizing the risk of adverse effects.

The Role of Psychological Support in Alopecia Areata Treatment

While the focus of this study is on the physical aspects of alopecia areata treatment, it’s important to acknowledge the psychological impact of hair loss. How can healthcare providers address this aspect of patient care?

Comprehensive care for alopecia areata patients should include:

Psychological assessment: Screening for anxiety, depression, and body image concerns
Support groups: Connecting patients with others experiencing similar challenges
Counseling: Providing access to mental health professionals experienced in dealing with appearance-related concerns
Education: Helping patients understand the nature of their condition and realistic treatment expectations
Cosmetic solutions: Offering information on wigs, scalp micropigmentation, and other cosmetic options for those who desire them

By addressing both the physical and psychological aspects of alopecia areata, healthcare providers can offer more comprehensive and effective care to their patients.

The Importance of Ongoing Research and Clinical Trials

The study by V.C. Fiedler-Weiss provides valuable insights into the use of minoxidil for alopecia areata, but it also highlights the need for ongoing research. Why is continued investigation in this field crucial?

Ongoing research and clinical trials are essential for:

Refining treatment protocols: Determining optimal concentrations, application methods, and treatment durations
Identifying biomarkers: Developing tests to predict treatment response and guide therapy selection
Exploring combination therapies: Investigating whether combining minoxidil with other treatments can enhance efficacy
Long-term follow-up: Understanding the long-term effects and safety of minoxidil use for alopecia areata
Developing new treatments: Continuing the search for novel therapies that may offer better results or fewer side effects

By supporting and participating in ongoing research efforts, both healthcare providers and patients can contribute to advancing the understanding and treatment of alopecia areata.

Navigating Insurance Coverage and Cost Considerations

While the efficacy and safety of minoxidil for alopecia areata are important considerations, practical aspects such as insurance coverage and cost can significantly impact treatment decisions. How can patients and healthcare providers address these issues?

Key considerations include:

Insurance coverage: Many insurance plans may not cover minoxidil for alopecia areata, as it’s considered off-label use
Over-the-counter availability: The 2% formulation is available without a prescription, potentially reducing costs
Generic options: Comparing brand-name and generic minoxidil products for cost savings
Patient assistance programs: Exploring manufacturer-sponsored programs that may offer discounts or financial assistance
Long-term budgeting: Helping patients understand the ongoing costs associated with long-term minoxidil use

By addressing these financial considerations upfront, healthcare providers can help patients make informed decisions about their treatment options and improve adherence to recommended therapies.

The Role of Diet and Lifestyle in Supporting Alopecia Areata Treatment

While topical minoxidil is the focus of this study, it’s worth considering how diet and lifestyle factors might complement medical treatments for alopecia areata. Can certain lifestyle changes support hair regrowth efforts?

Potential supportive measures include:

Balanced nutrition: Ensuring adequate intake of vitamins and minerals essential for hair health, such as biotin, iron, and vitamin D
Stress management: Practicing stress-reduction techniques, as stress may exacerbate alopecia areata in some cases
Gentle hair care: Avoiding harsh chemicals and excessive heat styling that could damage hair or irritate the scalp
Regular exercise: Promoting overall health and potentially improving circulation to the scalp
Adequate sleep: Ensuring sufficient rest to support the body’s natural repair and growth processes

While these lifestyle factors are unlikely to treat alopecia areata on their own, they may help create a more favorable environment for hair regrowth when combined with medical treatments like minoxidil.

Monitoring and Adjusting Treatment Over Time

Given the variable response to minoxidil treatment and the potential for changes in alopecia areata over time, how should patients and healthcare providers approach long-term management of this condition?

Effective long-term management strategies include:

Regular follow-up appointments: Assessing treatment response and monitoring for any side effects
Photographic documentation: Taking standardized photos to objectively track hair regrowth progress
Adjusting treatment as needed: Considering changes in concentration or combination with other therapies if response is suboptimal
Monitoring for recurrence: Being vigilant for signs of hair loss returning, even during ongoing treatment
Reassessing treatment goals: Periodically discussing the patient’s satisfaction with treatment and any changes in their priorities or concerns

By taking a proactive and adaptive approach to long-term management, healthcare providers can help patients achieve the best possible outcomes with minoxidil treatment for 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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