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

29.06.202112.07.2023 by alexxlab

How does topical minoxidil solution help in treating alopecia areata. What are the response rates for different concentrations of minoxidil. Can topical minoxidil induce hair regrowth in severe cases of alopecia areata. What factors may predict treatment response to minoxidil in alopecia areata patients. Are there any side effects associated with topical minoxidil use for alopecia areata.

Содержание

The Efficacy of Topical Minoxidil in Treating Alopecia Areata

Alopecia areata is a challenging autoimmune condition characterized by patchy hair loss. Researchers have been exploring various treatment options to combat this issue, with topical minoxidil emerging as a promising solution. A clinical trial conducted by V.C. Fiedler-Weiss has shed light on the effectiveness of topical minoxidil in treating alopecia areata.

The study compared the efficacy of 1% and 5% topical minoxidil solutions in 66 patients with alopecia areata. The results demonstrated a clear dose-response effect, with higher concentrations of minoxidil showing greater efficacy in promoting hair regrowth.

Response Rates for Different Minoxidil Concentrations

Can higher concentrations of minoxidil lead to better results in alopecia areata treatment? The study findings suggest so:

1% minoxidil solution: 38% response rate
5% minoxidil solution: 81% response rate

These response rates were observed in patients with extensive scalp hair loss (75% or greater). The significant difference in efficacy between the two concentrations highlights the importance of using an appropriate strength of minoxidil for optimal results.

Optimal Minoxidil Concentration for Alopecia Areata Treatment

While the study compared 1% and 5% minoxidil solutions, the researcher suggests that a 2% formulation may be the most effective for achieving cosmetically acceptable hair regrowth in patients with patchy alopecia areata. This recommendation balances efficacy with the potential for side effects that may occur at higher concentrations.

The Importance of Occlusion in Minoxidil Treatment

Is applying minoxidil solution alone sufficient for optimal results? The study indicates that occlusion of the treated area is crucial. Covering the area after applying minoxidil appears to be necessary to achieve and maintain maximum hair regrowth. This technique may enhance the absorption and effectiveness of the medication.

Factors Influencing Treatment Response to Minoxidil

Understanding which patients are more likely to respond to minoxidil treatment can help manage expectations and guide treatment decisions. The study identified several factors that may influence treatment outcomes:

Extent of Hair Loss

Patients with the most extensive scalp hair loss were found to be less responsive to minoxidil treatment. This suggests that early intervention may be crucial for achieving the best results.

T Cell Blastogenesis

An interesting finding from the study is that increased T cell blastogenesis before treatment may predict a positive response to minoxidil. This immunological marker could potentially be used to identify patients who are more likely to benefit from minoxidil therapy.

Other Clinical Features

The study found no other clinical features that correlated with treatment response. This highlights the complexity of alopecia areata and the need for individualized treatment approaches.

Long-Term Efficacy and Maintenance of Results

Does hair regrowth from minoxidil treatment last indefinitely? Unfortunately, the study indicates that hair loss often recurs after discontinuing treatment, particularly in patients with severe alopecia areata. In some cases, hair loss may even recur during ongoing treatment.

This observation underscores the importance of consistent, long-term use of minoxidil to maintain results. Patients should be counseled about the chronic nature of alopecia areata and the need for ongoing management.

Safety Profile of Topical Minoxidil in Alopecia Areata Treatment

When considering any medical treatment, safety is a paramount concern. The study provides valuable insights into the safety profile of topical minoxidil when used for alopecia areata:

Systemic Absorption

Is there a risk of systemic effects from topically applied minoxidil? The study found that systemic absorption of both 1% and 5% minoxidil solutions was minimal, even when the treated area was occluded. This suggests a low risk of systemic side effects.

Monitored Parameters

The researchers closely monitored various health parameters throughout the study. No clinically significant changes were observed in:

Blood pressure
Body weight
Cardiovascular status
Electrocardiogram (ECG) readings
Electrolyte levels
Complete blood count
Urinalysis results

These findings provide reassurance about the overall safety of topical minoxidil use in alopecia areata patients.

Local Side Effects

While systemic effects were minimal, some local side effects were noted:

Mild local irritation was reported by some patients
Two out of 66 patients (approximately 3%) developed allergic contact dermatitis to minoxidil, confirmed by patch testing

These local reactions, while generally mild, highlight the importance of monitoring patients for adverse effects and considering alternative treatments if necessary.

Comparative Efficacy of Minoxidil in Different Forms of Alopecia

While this study focused on alopecia areata, it’s worth noting that minoxidil has also shown efficacy in other forms of hair loss. A review by Clissold and Heel (1987) examined the use of topical minoxidil in both alopecia areata and androgenetic alopecia (male and female pattern baldness).

How does the efficacy of minoxidil compare between these different types of hair loss? While direct comparisons are challenging due to differences in study designs and patient populations, some general observations can be made:

Alopecia Areata: As seen in the Fiedler-Weiss study, minoxidil can be highly effective, particularly in patchy alopecia areata, with response rates up to 81% for 5% solutions.
Androgenetic Alopecia: Minoxidil is also effective for this condition, though response rates may be lower. Typical response rates range from 30-60%, depending on the study and minoxidil concentration used.

The difference in efficacy may be due to the distinct underlying mechanisms of these conditions. Alopecia areata is an autoimmune disorder, while androgenetic alopecia is hormone-mediated.

Optimizing Minoxidil Treatment for Alopecia Areata

Based on the findings of this study and related research, several strategies can be employed to optimize minoxidil treatment for alopecia areata:

Early Intervention

Given that patients with more extensive hair loss were less likely to respond, initiating treatment early in the course of alopecia areata may improve outcomes.

Appropriate Concentration

While 5% minoxidil showed the highest efficacy, the researcher suggests that a 2% formulation may offer the best balance of efficacy and tolerability for most patients with patchy alopecia areata.

Occlusion Technique

Covering the treated area after applying minoxidil appears to enhance its effectiveness. Patients should be instructed on proper occlusion techniques.

Long-Term Use

Given the tendency for hair loss to recur after discontinuing treatment, patients should be counseled on the importance of consistent, long-term use for maintaining results.

Monitoring and Follow-up

Regular follow-up appointments allow for assessment of treatment response and early detection of any adverse effects.

Combination Therapy

For patients with more severe or resistant cases, combining minoxidil with other treatments (such as topical corticosteroids or immunomodulators) may improve outcomes.

Future Directions in Alopecia Areata Research and Treatment

While topical minoxidil has shown promise in treating alopecia areata, there is still much to learn about optimizing its use and developing new treatment strategies. Some areas for future research include:

Biomarkers for Treatment Response

The observation that T cell blastogenesis may predict treatment response is intriguing. Further research into this and other potential biomarkers could help guide treatment decisions and improve outcomes.

Novel Formulations

Exploring new delivery methods or formulations of minoxidil could potentially enhance its efficacy or reduce side effects. For example, nanoparticle-based formulations or combination products with other active ingredients may offer advantages over current formulations.

Long-Term Outcomes

More extensive long-term studies are needed to better understand the sustained efficacy of minoxidil treatment and strategies for maintaining results over time.

Personalized Treatment Approaches

Given the variability in treatment response, research into factors that influence individual responsiveness could lead to more personalized and effective treatment strategies.

Combination Therapies

Further investigation into combining minoxidil with other treatments, such as JAK inhibitors or emerging biologic therapies, may yield more effective treatment protocols for resistant cases.

In conclusion, topical minoxidil has emerged as a valuable tool in the treatment of alopecia areata, offering hope to many patients struggling with this challenging condition. While it may not be a cure-all, its demonstrated efficacy and favorable safety profile make it an important option in the dermatologist’s armamentarium. As research continues, we can anticipate further refinements in its use and the development of even more effective treatment strategies 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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