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

25.06.202112.07.2023 by alexxlab

How does topical minoxidil solution affect hair regrowth in alopecia areata patients. What is the optimal concentration for treatment. Are there any side effects associated with topical minoxidil use in alopecia areata. How long does hair regrowth last after discontinuing minoxidil treatment.

Содержание

The Efficacy of Topical Minoxidil in Treating Alopecia Areata

Alopecia areata is a challenging condition characterized by patchy hair loss. Researchers have explored various treatment options, with topical minoxidil emerging as a promising solution. A clinical trial conducted by V.C. Fiedler-Weiss investigated the effectiveness of topical minoxidil solution in treating alopecia areata.

The study compared the efficacy of 1% and 5% minoxidil solutions in promoting hair regrowth. A total of 66 patients participated, with 26 individuals taking part in both study groups. The results revealed a clear dose-response effect, demonstrating that higher concentrations of minoxidil were more effective in stimulating hair regrowth.

Response Rates Based on Minoxidil Concentration

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

These findings suggest that patients with extensive scalp hair loss (75% or greater) are more likely to experience significant improvement with higher concentrations of minoxidil.

Optimal Minoxidil Concentration for Alopecia Areata Treatment

While the study compared 1% and 5% minoxidil solutions, the current standard formulation available for treatment is 2% minoxidil. This concentration has been found to be most effective in producing cosmetically acceptable hair regrowth, particularly in patients with patchy alopecia areata.

Why is the 2% formulation considered optimal? It strikes a balance between efficacy and minimizing potential side effects. Higher concentrations may provide more dramatic results but could also increase the risk of adverse reactions.

Factors Influencing Treatment Success

Several factors can impact the effectiveness of topical minoxidil treatment for alopecia areata:

Extent of hair loss: Patients with more extensive hair loss may be less responsive 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
Treatment duration: Consistent, long-term application is often required for optimal results

The Role of Occlusion in Minoxidil Treatment

One intriguing aspect of the study was the importance of occlusion in maximizing treatment efficacy. Covering the treated area after applying minoxidil solution appears to enhance its absorption and effectiveness.

How does occlusion improve minoxidil’s performance? By creating a barrier over the treated scalp, occlusion can:

Increase skin hydration, potentially enhancing drug penetration
Reduce evaporation of the minoxidil solution, allowing for prolonged contact with the scalp
Create a microenvironment that may be more conducive to hair follicle stimulation

Patients using topical minoxidil for alopecia areata should consider incorporating occlusion techniques into their treatment regimen, under the guidance of their dermatologist.

Predicting Treatment Response in Alopecia Areata Patients

Identifying patients who are likely to respond well to minoxidil treatment can help manage expectations and guide treatment decisions. The study revealed some interesting insights into potential predictors of treatment success.

T Cell Blastogenesis as a Predictor

Increased T cell blastogenesis before treatment initiation may indicate a higher likelihood of positive response to minoxidil. This finding suggests that certain immunological factors play a role in determining treatment outcomes.

Why might T cell activity predict treatment response? Alopecia areata is an autoimmune condition, and T cells are key players in the immune system. Their heightened activity could indicate a more responsive immune environment, potentially making the hair follicles more susceptible to the growth-promoting effects of minoxidil.

Extent of Hair Loss and Treatment Response

The study found that patients with the most extensive scalp hair loss were less likely to respond to minoxidil treatment. This observation highlights the importance of early intervention in alopecia areata cases.

What factors might contribute to poor response in extensive hair loss?

Longer duration of the disease may lead to more permanent damage to hair follicles
Extensive hair loss could indicate a more aggressive form of alopecia areata
The immune-mediated destruction of hair follicles may be more advanced in severe cases

Long-Term Efficacy and Maintenance of Hair Regrowth

While topical minoxidil can stimulate hair regrowth in many alopecia areata patients, maintaining these results over time can be challenging. The study provided valuable insights into the long-term efficacy of minoxidil treatment.

In patients with severe alopecia areata, hair loss often recurred after discontinuing treatment. Some patients even experienced hair loss recurrence during ongoing treatment. This highlights the chronic nature of alopecia areata and the need for continued management.

Strategies for Maintaining Hair Regrowth

Consistent, long-term use of topical minoxidil
Regular follow-ups with a dermatologist to monitor progress and adjust treatment as needed
Combining minoxidil with other treatments, such as topical corticosteroids or immunomodulators
Addressing underlying factors that may contribute to alopecia areata, such as stress or nutritional deficiencies

Patients should be counseled on the importance of adherence to their treatment regimen and the potential need for long-term maintenance therapy to sustain hair regrowth.

Safety Profile of Topical Minoxidil in Alopecia Areata Treatment

The study also provided valuable information on the safety of topical minoxidil use in alopecia areata patients. Overall, the treatment was well-tolerated with minimal systemic absorption, even when using higher concentrations (1% and 5%) with occlusion.

Systemic Effects

No clinically significant changes were observed in:

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

These findings suggest that topical minoxidil, when used as directed, has a favorable safety profile with minimal risk of systemic side effects.

Local Side Effects

While systemic side effects were rare, some patients experienced local reactions:

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

These local side effects were generally mild and manageable. However, patients should be advised to monitor for any signs of irritation or allergic reactions and report them to their healthcare provider promptly.

Comparison of Topical Minoxidil to Other Alopecia Areata Treatments

While this study focused on topical minoxidil, it’s important to consider how it compares to other treatments available for alopecia areata. Understanding the relative efficacy and safety of different options can help guide treatment decisions.

Topical Corticosteroids

Topical corticosteroids are often considered a first-line treatment for alopecia areata. How do they compare to minoxidil?

Efficacy: Both can be effective, but response rates may vary depending on the extent of hair loss
Mechanism: Corticosteroids work by suppressing the immune response, while minoxidil promotes hair growth directly
Side effects: Corticosteroids may cause skin atrophy with long-term use, while minoxidil’s side effects are generally milder

Intralesional Corticosteroids

Intralesional corticosteroid injections are another common treatment for alopecia areata. Comparing them to topical minoxidil:

Efficacy: Intralesional injections may provide faster results in small, patchy areas
Convenience: Topical minoxidil is easier to apply at home, while injections require office visits
Pain: Injections can be uncomfortable, whereas topical application is painless

Immunomodulators

Newer treatments like Janus kinase (JAK) inhibitors have shown promise in treating alopecia areata. How do they stack up against minoxidil?

Efficacy: JAK inhibitors may be more effective, especially in severe cases
Safety: Long-term safety data for JAK inhibitors is still emerging, while minoxidil has a well-established safety profile
Cost: JAK inhibitors are generally more expensive than topical minoxidil

The choice of treatment should be individualized based on factors such as the extent of hair loss, patient preferences, and potential side effects. In many cases, a combination of treatments may provide the best results.

Future Directions in Alopecia Areata Treatment Research

While topical minoxidil has shown promise in treating alopecia areata, ongoing research continues to explore new and potentially more effective treatments. What areas of research hold the most promise for future alopecia areata therapies?

Targeted Immunotherapies

As our understanding of the immune mechanisms underlying alopecia areata improves, researchers are developing more targeted therapies:

JAK inhibitors: Both oral and topical formulations are being studied
Interleukin inhibitors: Targeting specific inflammatory pathways involved in hair loss
T cell-targeted therapies: Aiming to modulate the autoimmune response more precisely

Combination Therapies

Exploring synergistic effects of combining different treatments may lead to improved outcomes:

Minoxidil with immunomodulators: Potentially enhancing both immune regulation and direct hair growth stimulation
Topical and systemic therapies: Addressing both local and systemic aspects of the disease
Nutritional supplements with pharmacological treatments: Supporting overall hair health alongside targeted therapies

Personalized Medicine Approaches

Advancing our ability to predict treatment response and tailor therapies to individual patients:

Genetic profiling: Identifying genetic markers that may predict treatment response or disease course
Biomarker discovery: Developing tests to guide treatment selection and monitor disease activity
Artificial intelligence: Using machine learning algorithms to optimize treatment protocols based on patient characteristics

As research progresses, the management of alopecia areata is likely to become more sophisticated and personalized, potentially leading to better outcomes for patients struggling with this challenging condition.

Patient Education and Support in Alopecia Areata Management

Effective treatment of alopecia areata extends beyond just medical interventions. Patient education and support play crucial roles in achieving optimal outcomes and improving quality of life for those affected by this condition.

Understanding Treatment Expectations

Educating patients about the nature of alopecia areata and realistic treatment expectations is essential:

Treatment timelines: Explaining that hair regrowth can take several months to become noticeable
Potential for relapse: Discussing the chronic nature of the condition and the possibility of recurrence
Importance of adherence: Emphasizing the need for consistent, long-term treatment

Psychological Support

The emotional impact of hair loss should not be underestimated. Providing resources for psychological support can be beneficial:

Referrals to mental health professionals specializing in chronic conditions
Information about support groups and patient organizations
Strategies for coping with the psychological effects of hair loss

Lifestyle Factors

Educating patients about lifestyle factors that may influence their condition:

Stress management techniques: As stress can exacerbate alopecia areata
Nutritional guidance: Ensuring a balanced diet to support overall hair health
Hair care practices: Advice on gentle hair care to avoid further damage

By addressing these aspects alongside medical treatment, healthcare providers can offer a more comprehensive approach to managing alopecia areata, potentially improving both treatment outcomes and patient quality of life.

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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