Journal Pre-proof
Oral minoxidil treatment for hair loss: A review of efficacy and safety
Michael Randolph, BS, Antonella Tosti, MD
PII:

S0190-9622(20)32109-5

DOI:

https://doi.org/10.1016/j.jaad.2020.06.1009

Reference:

YMJD 14907

To appear in:

Journal of the American Academy of Dermatology

Received Date: 18 April 2020
Revised Date:

19 June 2020

Accepted Date: 29 June 2020

Please cite this article as: Randolph M, Tosti A, Oral minoxidil treatment for hair loss: A review
of efficacy and safety, Journal of the American Academy of Dermatology (2020), doi: https://doi.org/10.1016/j.jaad.2020.06.1009.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the additionof a cover page and metadata, and formatting for readability, but it is not yet the definitive version ofrecord. This version will undergo additional copyediting, typesetting and review before it is publishedin its final form, but we are providing this version to give early visibility of the article. Please note that,during the production process, errors may be discovered which could affect the content, and all legal
disclaimers that apply to the journal pertain.
© 2020 Published by Elsevier on behalf of the American Academy of Dermatology, Inc.

Capsule summary•

This review discusses the limitations of topical minoxidil for hair loss treatment and assesses oral
minoxidil as an emerging treatment alternative.

•

Low dose oral minoxidil is an effective and safe treatment alternative for a variety of hair loss
disorders in healthy patients having difficulties with topical minoxidil preparations.

Article type: Review
Title: Oral minoxidil treatment for hair loss: A review of efficacy and safety
Michael Randolph, BS1, Antonella Tosti, MD1
1Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of
Medicine
Corresponding author:
Dr.Antonella Tosti,
University of Miami Hospital
Department of Dermatology and Cutaneous Surgery
1475 NW 12th 14 Ave. Suite 2175
Miami, FL 33136
Email: atosti@med.miami.edu
Funding sources:
None
Conflicts of Interest:
Michael Randolph has nothing to disclose.
Antonella Tosti Consultant or advisor: DS Laboratories, Monat Global, Almirall, Tirthy Madison, Lilly, Leo
Pharmaceuticals, Bristol Myers Squibb , P&G
Manuscript word count: 2033 words
Abstract word count: 196
Capsule summary word count: 48
Title page word count: 141
References: 36
Figures: 0
Tables: 2
Supplementary tables: 0
Reprint Request: Michael Randolph
Keywords: Oral minoxidil; systemic minoxidil; minoxidil; hair loss; alopecia; androgenetic alopecia; efficacy; safety;
alopecia treatment

Abstract
Background: Although topical minoxidil is an effective treatment option for hair loss, many patientsare poorly compliant due to the necessity to apply the medication twice a day, undesirable hair
texture, and scalp irritation.
Objective: In recent years, oral minoxidil at low dose has been proposed as a safe alternative. This study
reviewed articles in which oral minoxidil was utilized to treat hair loss to determine its efficacy andsafety as an alternative to topical minoxidil.
Methods: PubMed searches were performed to identify articles discussing oral minoxidil as the primary form oftreatment for hair loss published up to April 2020.
Results: A total of 16 studies with 622 patients were found discussing the use of oral minoxidil as theprimary treatment modality for hair loss. Androgenetic alopecia was the most studied condition, butother conditions included: telogen effluvium, lichen planopilaris, loose anagen hair syndrome,monilethrix, alopecia areata, and permanent chemotherapy induced alopecia.
Limitations: Larger randomized studies comparing the efficacy/safety of different doses withstandardized objective measurements will be needed to clarify the best treatment protocol.
Conclusion: Oral minoxidil was found to be an effective and well-tolerated treatment alternative forhealthy patients having difficulty with topical formulations.

Introduction:

Minoxidil was first introduced in the 1970s as a treatment for severe refractory hypertension
due to its potent vasodilatory qualities. Minoxidil has a relaxant effect on vascular smooth muscle
through the opening of ATP sensitive potassium channels (1). During this time, hypertrichosis andregrowth of hair was found to be a common side effect among users and a topical preparation was firstmarketed in 1986 (2–7). For several decades, minoxidil has been utilized as 2% and 5% topical solutions,and later, 5% foam for the treatment of a variety of alopecia in both men and women although only
approved for androgenetic alopecia (AGA). The exact mechanism of action remains unknown, though
the conversion of minoxidil to its active derivative, minoxidil sulphate, by follicular sulfotransferase
activity is a key step in the medication’s effectiveness (8,9). Minoxidil causes a shortening of the telogen
phase and lengthening of the anagen phase with a progressive growth in hair follicle diameter andlength (10,11). The topical formulation must continue to be applied, or beneficial effects will regress(12). The adverse effects are largely cutaneous with the most common complaints being scalp pruritus,
scalp scaling, and hypertrichosis. Contact dermatitis can also develop over time (13–15).
Although topical minoxidil is an effective treatment option for hair loss, many patients arepoorly compliant due to the necessity to apply the medication twice a day, undesirable hair texture, andscalp irritation. Patients must also be made aware of a temporary shedding period that occurs following
the initiation of topical application. If unaware of this side effect, patients may discontinue use
prematurely.
Until recently, oral minoxidil (OM) has not been used for treatment of hair loss due to thepotential side effects of the medication when used at doses between 10-40 mg daily. Sodium and fluid
retention have been shown to be a significant adverse effect, especially in patients with renal
conditions. This adverse effect will commonly present as edema or weight gain, although it may
infrequently cause pulmonary congestion. Co-administration with beta blockers was common to reducesodium/fluid retention and controlling heart rate (16). Acute pulmonary edema and pulmonary
hypertension have also been reported as possible side effects, although a direct causal relationship has
yet to be proven (17). Cardiac conditions associated with the medication include, most commonly, reflex
tachycardia and, less commonly, EKG changes, pericardial effusion, and congestive heart failure inpatients with advanced renal disease (18). The dose related side effects were studied for the use ofminoxidil as an antihypertensive agent, with a typical maintenance dose between 10-40 mg daily (19).
Use of low dose OM overcomes many of these therapeutic limitations and has recently become
more popular with several studies and reports published on its efficacy and safety .This review will
analyze the available studies to determine the effectiveness and safety of OM as a treatment option forhair loss.
Methods:
Keyword searches of PubMed were performed to identify all articles discussing oral minoxidil
treatment of hair loss until April 2020. Search terms included “oral minoxidil,” “hair loss,” “systemicminoxidil,” “alopecia.” No language or time restrictions were used. Articles found were read andreviewed; they were judged appropriate for inclusion if they described treatment of hair loss primarily
with OM. The references of these articles were reviewed to identify additional resources.
Results:-Efficacy
A total of 16 studies with 622 patients were found discussing the use of oral minoxidil as theprimary treatment modality for hair loss. AGA was the most studied condition. In general, OM wasfound to be an effective treatment for AGA. In the largest study, Rodrigues-Barata et al. determined amean dose of 1mg of OM in 148 women to be an effective form of treatment for FPH (20)L. Response totherapy was more significant in patients with more advanced stages of FPHL. Although a large portion ofpatients in this study were taking concomitant treatments, little difference in effectiveness was reported
between patients on OM monotherapy and patients on OM plus additional treatment (20). Sinclair R.

utilized 0.25mg minoxidil daily in women with female pattern hair loss and showed improvement in the
Sinclair hair loss severity score and hair shedding score through 1 year of treatment (21). OM wasassociated with spironolactone 25 mg daily to reduce the risk of fluid retention. Additionally, 50 mg of
sodium chloride was added to the capsule for women with low blood pressure.
At a dosage of 1.25 mg daily, Beach et al. studied OM for treatment of AGA and traction
alopecia in 18 patients, 17 of which were female, for an average duration of 6 months. At follow up, 33%of patients reported decreased hair shedding, and 28% reported increased scalp hair (22). Similar
improvements were noted by Jha et al. in males on 1.25 mg, however, a higher dosage may benecessary if no response is noticed within 6 months (23). Ramos et al., compared efficacy of 1 mg daily
OM to topical 5% solution daily and found OM to be as effective as the topical solution. Parietal hairdensity measured through a blinded analysis of trichoscopic images was the primary endpoint in thisstudy (24). Ramos et al. also indicated that a lower follicular sulfotransferase activity threshold is needed
for bio-activation of OM compared to topical minoxidil (25). Additionally, in this study, OM produced
better improvement of hair shedding score indicating favorable results for treatment of telogen
effluvium (24). The improved hair shedding score supported findings by Perera and Sinclair in which OM
effectively treated chronic telogen effluvium in females. In this study, most women (29 of 36) were on 1
mg or less daily (26).
In male AGA, Lueangarun et al., studied the use of a 5 mg daily dose. Measured over 24 weeks,photographs showed 100% improvement with 43% of men having “remarkable” improvement. With alonger duration of treatment, more patients showed remarkable improvement. Additionally, they found
OM to be effective both in the vertex and frontal area, although the vertex showed greater progress(27). Similarly, Jimenez-Cuahe et al., studied male AGA treated with 5 mg or 2.5 mg daily dose. In a
subgroup of patients treated with OM monotherapy, mostly at 5 mg, all showed clinical improvementwith 37.5% showing marked improvement (28). When using a lower dose of 0.25 mg, which was foundto be effective in Female Pattern Hair Loss (FPHL), Pirmez and Salas-Callo found improvement or
stabilization in 40-60% of male patients treated for AGA. However, it was not considered statisticallysignificant when hair thickness and density were evaluated with the Tricholab system (29). Current data
indicate that 2.5 mg- 5 mg daily doses are more effective in treating males with AGA. However, larger
prospective studies with standardized objective measurements are needed to truly elucidate theoptimum dosing protocol for both male and female patients. Interestingly, Sinclair et al. examined theuse of sublingual administration of minoxidil as it bypasses hepatic metabolism for greater bioavailability(30). At a dosage of 0.45 mg daily, both male and female patients had improvements in multiple
measurements including Sinclair stage, Sinclair hair shedding score, and International Global Assessment(IGA) (30).
A recent retrospective analysis by Vano-Galvan et al. showed OM (0.5 mg daily for women and2.5 mg daily for men) improved or maintained hair thickness in a majority of patients with classicallichen planopilaris and was especially beneficial for patients with diffuse lichen planopilaris (31). In
addition to AGA, telogen effluvium, and lichen planopilaris the review found case reports of OM therapy
proving to be useful in the treatment of loose anagen hair syndrome, monilethrix, alopecia areata, andpermanent chemotherapy induced alopecia as described in table 1.

-Safety
This review found OM to be well tolerated with only minor adverse effects described in theliterature. The most reported side effect was hypertrichosis, which was reported in approximately one
fifth of patients. Interestingly, hypertrichosis was almost never a cause for discontinuation of the
medication as many patients considered it only a mild side effect and easily manageable. Overall,
hypertrichosis was more common among patients who used 5 mg daily and was seen in a little over halfof these patients (27,28,32). A dose of 0.25 mg had the lowest incidence of hypertrichosis (less than 10%

of patients) (21,29). Although, hypertrichosis seems to be dose related, larger studies are needed toaccurately determine the true incidence. Areas of hypertrichosis described in the studies included theface and body. Therianou et al. showed 0.25 mg twice daily OM to be a satisfactory and safe alternative
to topical solutions in women who develop acute contact dermatitis to propylene glycol in topicalminoxidil solutions (33). As with topical minoxidil, OM is associated with a temporary period of
increased hair shedding that can last 3-6 weeks. Patients should be warned of this possible side effect toavoid premature discontinuation of treatment. Most studies did not report this side effect, but Sinclair
et al. reported 22 out of 100 women found this increase in shedding to be of significant concern. No
women discontinued treatment due to this side effect, and shedding ceased for most of these women
within 4 weeks (21).
Cardiovascular adverse effects were overall rare and relatively minor. Blood pressure wasmonitored in some of the studies with only minor changes (21,22,26,30). Ramos et al. found nodifference in mean blood pressure when comparing groups who used topical minoxidil as opposed tooral administration, however OM did increase heart rate by 6.5% (24). Postural hypotension/dizziness
was reported in about 2% of patients. Sinclair described use of 50mg of sodium chloride daily fortreatment of patients reporting postural hypotension (21). Lower limb edema was only seen inapproximately 3% of patients, a majority of which were on 5 mg. Of these patients, only 1 discontinued
due to the edema (28). EKG changes were reported in approximately 1% of cases, however, it is unclear
if patients were regularly examined with EKG as this was only reported in one study. The EKG changes
were mild and consisted of tachycardia, PVC, and T wave changes in lead 1 (20,27). No severe
cardiopulmonary events were reported in any study.

Discussion:

Introduced in the 1970s, OM was originally intended for treatment of severe refractory
hypertension. Hypertrichosis was quickly noted as a frequent side effect and topical option was created
to provide the hair growth benefits of minoxidil while circumventing the unwanted, and occasionallysevere, side effects of OM. However, the topical preparation is not without limitation as patientcompliance is frequently low.
This review found that OM has promising results as an effective and safe option for a variety ofhair loss conditions including AGA, chronic telogen effluvium, traction alopecia, loose anagen syndrome,
alopecia areata, monilethrix, chemotherapy induced hair loss and even scarring alopecia . AGA infemales was the most studied condition, with dosages between 0.25 mg to 1.25 mg proving to beeffective and safe. The combination of 0.25 mg minoxidil and 25 mg of spironolactone may prove to be
the best option as the low dose of OM limits side effects while spironolactone aids in reducing
fluid/sodium retention properties of minoxidil. In male AGA, low doses of OM (0.25 mg) were found to
be less effective. Effective treatment in males was seen with 2.5 mg or 5 mg minoxidil daily. Larger
studies comparing efficacy of different doses with standardized objective measurements will be needed
to clarify the best treatment protocol.
As an antihypertensive agent, minoxidil was typically used at 10-40 mg daily maintenance doses.
At this amount, minoxidil was associated with several severe cardiopulmonary side effects. However,this review has found OM at lower doses (< 5 mg) to be tolerable with few and mild side effects. By far,the most common side effect was hypertrichosis, which was reported as mild and easily manageable.
Other less common side effects include postural hypotension/dizziness, lower limb edema, mild bloodpressure changes, and EKG changes. No severe cardiopulmonary side effects were noted. However,providers must remain cautious and continue to monitor patient blood pressure, heart rate, and signs of
fluid retention such as weight gain and pedal edema. Additionally, physicians should recognize OM as an
option for healthy young patients who are having difficulty with the topical formulation.

References:1.

Meisheri KD, Cipkus LA, Taylor CJ. Mechanism of action of minoxidil sulfate-induced vasodilation:
A role for increased K+ permeability. J Pharmacol Exp Ther. 1988;245(3):751–60.

2.

Zappacosta A. Reversal of baldness in patient receiving minoxidil for hypertension.
1980;303(25):1480.

3.

Olsen E, DeLong E, Weiner M. Dose-response study of topical minoxidil in male pattern alopecia.
J Am Acad Dermatol. 1986;15(1):673–6.

4.

Wester RC, Maibach HI, Guy RH, Novak E. Minoxidil stimulates cutaneous blood flow in humanbalding scalps: Pharmacodynamics by laser Doppler velocimetry and photopulse
plethysmography. J Invest Dermatol [Internet]. 1984;82(5):515–7. Available from:http://dx.doi.org/10.1111/1523-1747.ep12261084

5.

Vanderveen EE, Ellis CN, Kang S, Case P, Headington JT, Voorhees JJ, et al. Topical minoxidil forhair regrowth. J Am Acad Dermatol. 1984;11(3):416–21.

6.

Javier R, Dumler F, Park J, Bok D, Riley R, Levin N. Long-term treatment with minoxidil in patientswith severe renal failure. 1980. p. 149–55.

7.

Weiss VC, West DP, Mueller CE. Topical minoxidil in alopecia areata. J Am Acad Dermatol.
1981;5(2):224–6.

8.

Buhl A, Waldon D, Baker C, GA. J. Minoxidil sulfate is the active metabolite that stimulates hairfollicles. J Invest Dermatol. 1990;95(5):553–7.

9.

Goren A, Castano JA, McCoy J, Bermudez F, Lotti T. Novel enzymatic assay predicts minoxidil
response in the treatment of androgenetic alopecia. Dermatol Ther. 2014;27(3):171–3.

10.

Messenger A, Rundegren J. Minoxidil: mechanisms of action on hair growth. Br J Dermatol.
2004;150(2):186–94.

11.

E. A. Histologic response to topically applied minoxidil in male-pattern alopecia. Clin
Dermatology. 1988;6(4):191–4.

12.

Price VH, Menefee E, Strauss PC. Changes in hair weight and hair count in men with androgenetic
alopecia, after application of 5% and 2% topical minoxidil, placebo, or no treatment. J Am Acad
Dermatol. 1999;41(5 I):717–21.

13.

Friedman ES, Friedman PM, Cohen DE, Washenik K. Allergic contact dermatitis to topicalminoxidil solution: Etiology and treatment. J Am Acad Dermatol. 2002;46(2):309–12.

14.

Dawber RPR, Rundegren J. Hypertrichosis in females applying minoxidil topical solution and innormal controls. J Eur Acad Dermatology Venereol. 2003;17(3):271–5.

15.

Tosti A, Bardazzi F, De Padova M, Caponeri G, Melino M, Veronesi S. Contact dermatitis tominoxidil. Contact Dermatitis. 1985;13(4):275–6.

16.

Gilmore E, Weil J, Chidsey C. Treatment of essential hypertension with a new vasodilator in
combination with beta-adrenergic blockade. N Engl J Med. 1970;282(10):521–7.

17.

Atkins JM, Mitchell HC, Pettinger WA. Increased pulmonary vascular resistance with systemic
hypertension. Effect of minoxidil and other antihypertensive agents. Am J Cardiol.

1977;39(6):802–7.
18.

Campese V, Stein D, DeQuattro V. Treatment of severe hypertension with minoxidil: advantages
and limitations. J Clin Pharmacol. 1979;19(4):231–41.

19.

Sica DA. Minoxidil: an underused vasodilator for resistant or severe hypertension. J Clin
Hypertens (Greenwich). 2004;6(5):283–7.

20.

Rodrigues-Barata R, Moreno-Arrones OM, Saceda-Corralo D, Jiménez-Cauhé J, Ortega-Quijano D,
Fernández-Nieto D, et al. Low-Dose Oral Minoxidil for Female Pattern Hair Loss: A Unicenter
Descriptive Study of 148 Women. Skin Appendage Disorders. 2020.

21.

Sinclair RD. Female pattern hair loss: A pilot study investigating combination therapy with lowdose oral minoxidil and spironolactone. Int J Dermatol. 2018;57(1):104–9.

22.

Beach RA. Case series of oral minoxidil for androgenetic and traction alopecia: Tolerability & thefive C’s of oral therapy. Dermatol Ther. 2018;31(6):1–2.

23.

Jha A, Sonthalia S, Zeeshan, Vinay K. Efficacy and safety of very low dose oral minoxidil 1.25mg inmale androgenetic alopecia. J Am Acad Dermatol. 2020;

24.

Ramos PM, Sinclair RD, Kasprzak M, Miot HA. Minoxidil 1 mg oral versus minoxidil 5% topicalsolution for the treatment of female-pattern hair loss: A randomized clinical trial. J Am Acad
Dermatol [Internet]. 2020;82(1):252–3. Available from:https://doi.org/10.1016/j.jaad.2019.08.060

25.

Ramos PM, Goren A, Sinclair R, Miot HA. Oral minoxidil bio-activation by hair follicle outer root
sheath cell sulfotransferase enzymes predicts clinical efficacy in female pattern hair loss. J Eur
Acad Dermatology Venereol. 2020;34(1):e40–1.

26.

Sinclair R, Perera E. Treatment of chronic telogen effluvium with oral minoxidil: A retrospective
study. F1000Research. 2017;6(0):1–9.

27.

Lueangarun S, Panchaprateep R, Tempark T, Noppakun N. Efficacy and safety of oral minoxidil 5
mg daily during 24-week treatment in male androgenetic alopecia. J Am Acad Dermatol.
2015;72(5):AB113.

28.

Jimenez-Cauhe J, Saceda-Corralo D, Rodrigues-Barata R, Hermosa-Gelbard A, Moreno-Arrones
OM, Fernandez-Nieto D, et al. Effectiveness and safety of low-dose oral minoxidil in maleandrogenetic alopecia. J Am Acad Dermatol. 2019;81(2):648–9.

29.

Pirmez R, Salas-Callo CI. Very-low-dose oral minoxidil in male androgenetic alopecia: A study withquantitative trichoscopic documentation. J Am Acad Dermatol [Internet]. 2020;82(1):e21–2.
Available from: https://doi.org/10.1016/j.jaad.2019.08.084

30.

Sinclair R, Trindade de Carvalho L, Ismail FF, Meah N. Treatment of male and female pattern hairloss with sublingual minoxidil: a retrospective case-series of 64 patients. J Eur Acad Dermatology
Venereol. 2020;

31.

Vano-Galvan S, Trindade de Carvalho L, Saceda-Corralo D, Rodrigues-Barata R, Kerkemeyer K,
Sinclair R, et al. Oral minoxidil improves background hair thickness in lichen planopilaris. J Am
Acad Dermatol [Internet]. 2020; Available from: https://doi.org/10.1016/j.jaad.2020.04.026

32.

Wambier CG, Craiglow BG, King BA. Combination tofacitinib and oral minoxidil treatment forsevere alopecia areata. J Am Acad Dermatol [Internet]. 2019; Available from:https://doi.org/10.1016/j.jaad.2019.08.080
33.

Therianou A, Vincenzi C, Tosti A. How safe is prescribing oral minoxidil in patients allergic to
topical minoxidil? J Am Acad Dermatol [Internet]. 2020; Available from:https://doi.org/10.1016/j.jaad.2020.04.027

34.

Cranwell WC, Sinclair R. Loose anagen hair syndrome: Treatment with systemic minoxidil
characterised by marked hair colour change. Australas J Dermatol. 2018;59(4):e286–7.

35.

Sinclair R. Treatment of monilethrix with oral minoxidil. JAAD Case Reports [Internet].
2016;2(3):212–5. Available from: http://dx.doi.org/10.1016/j.jdcr.2016.02.011

36.

Yang X, Thai K-E. Treatment of permanent chemotherapy-induced alopecia with low dose oral
minoxidil. Australas J Dermatol. 2016;57(4):e130–2.

Table 1: Summary of adverse effects with varying oral minoxidil dosages.
*=Sublingual administration
ᶧ=Includes data from Rodrigues-Barata R., et al. Patients took a range of dosages, however mean dose
was 1mg and multivariate analysis revealed no significant statistical differences between dosages.

Minoxidil
Dosage0.25mg0.45mg*0.5mg
1 mgᶧ
1.25 mg
2.5 mg
5 mg
Total:

Males Female

Hypertrichosis

25
33
0
0
33
10
66
167

9 (6.8%)8 (12%)
4 (27%)
46 (21%)8 (16%)
13 (52%)36 (55%)117 (20.5%)

106
31
15
220
17
15
0
404

Lower Limb
Edema
1 (0.7%)2 (3.1%)0
3 (1.4%)
1 (2%)
1 (4%)
5 (7.6%)13 (2.2%)

Hypotension EKG changes
3 (2.3%)5 (7.8%)0
1 (1.4%)1 (5.5%)00
10 (1.8%)0002 (0.9%)00
3 (4.5%)5 (0.9%)

Table 2: Summary of studies
AGA= Androgenetic Alopecia F= Female,
M= Male,y/o= years old,
OM= Oral minoxidil,
FPHL= Female Pattern Hair Loss,
TM= Topical Minoxidil,
SALT= Severity of Alopecia Tool LLLT= Low Level Light Therapy PRP= Platelet Rich Plasma

Author

DiseaseDosage/Regimen

Number ofparticipants

Results

Adverse Effects

VanoGalvan etal. 2020(31)

LichenMedianplanopilari daily dose=s
0.5 mg daily
for female
2.5 mg daily
for male

Total n=51
(36 F, 15 M)

20 patients (39%) had
improved hair thickness

27% (n=14)
hypertrichosis

Mean age= 55
y/o

27 patients (53%)
remained stable

6% (n=3)
posturalhypotension

Averageduration=
21 months

Therianou
et al.
2020(33)

FPHL withcontactdermatitis
topropylene
glycol in
2% and5%solutionsof TM.

There were
no changes
toconcomitanttherapies
within thelast 6months.
0.25 mg
Total n=9
twice per
(9F, 0M)
day
Averageduration of
17 months

4 patients (8%) had
worsening hair thickness
Improvement was more
likely with higher doses
in male patients.

4% (n=2)
tachycardia
2% (n=1) weightgain

Diffuse LPP was
associated with a better
response than patchy LPP

All patients satisfied withtreatment.

22% (n=2)
Facialhypertrichosis

Beach etal. 2018(22)

AGA
Tractionalopecia

1.25 mgnightly

Total n=18 (17F, 1 M)

33% had decreased hair
shedding

Averageduration ofprescription= 6 months

AGA n= 14 (13F, 1M)

28% had increased scalp
hair

All patientspreviously
on topicalminoxidil

CranwellW.,
Sinclair S.
2018
(34)

Loose
anagenhair
syndrome

Perera E.,
Sinclair R.
2017
(26)

Chronic
telogeneffluvium

Traction
Alopecia n= 4
(4F, 0M)

39%(n=7)
hypertrichosis
of faceIn all but 1
patient, bloodpressureremained
normal or
improved in
hypertensive
patients.

Average age=
41 y/o

0.5 mg daily

n=1 (1 F)

Previously
on 5%
topicalsolution for
5 years.

11 y/oVariedbetween
0.25mg to
2.5mg
daily
(29 patientsused 1 mg
or less daily)

n=36 (36F,
0M)

Baseline Hair Shedding
Score (HSS)= 5.64

Average
age=46.9 y/o

6-month HSS=3.9

5 at 0.25 mg
4 at 0.5 mg
19 at 1 mg
8 at 2.5 mg

6%(n=1)
hypotension
and urticaria

Shedding and hairdensity improved in first
3 months.

No heart ratechanges were
found.
Hair color
change fromreddish-brown
to light brown.

Discontinued after 12months, no recurrence.

12-month HSS=3.05

n=2experienced
transientposturalhypotensionthat resolved.
n=1
ankle edema
n=14
hypertrichosis
Average bloodpressurechange:
S: -0.5mmHg
D: +2.1mmHg

JimenezCauh et
al.
2019
(28)

AGA

5 mg daily(10 patients
received 2.5
mg daily, 31
patients
received 5
mg daily)n=41 (41M,
0F)
Oral minoxidil(OM)
monotherapy
n= 16
Average age=33.3 y/oPirmez R.,
SalasCallo C.I.
2019
(29)

Lueangarun S., et
al.
2015
(27)

AGA

0.25mgdaily
Measured:-total hairdensity-density ofterminal
hair-new hairs-newterminal
hairs.

AGA

5 mg dailyfor 24weeks

n=25 (25M,0F) all on
monotherapy
Average age=
36.7 y/o37 (90.2%) had clinicalimprovement.
11 (26.8%) had marked
improvement.
4 (9.8%) showedstabilization
Of OM monotherapy
subgroup: All had clinicalimprovement with 6(37.5%) showing marked
improvement.
OM at a dose of 5 mg
daily was effective andpresented an acceptablesafety profile
Improvement or
stabilization was seen ina percentage of patients,
but not found to bestatistically significant.

n=10 (24.3%)
hypertrichosis
n=2 (4.8%)
lower limb
edema, onepatient
discontinued

n=5 (20%) body
hypertrichosis
n=4 (16%) hair
shedding

Higher doses such as
2.5mg or 5mg
might be necessary forsignificant effects in men

n=1 (4%) pedal
edema

n=30 (30M,0F) vertex area revealed
100%
Average
improvement.
age=38 y/oremarkable improvementin 43% of patients.

93%hypertrichosis

n=10 mild
AGA
n=15 severe
AGA

Significantly increased
total hair count at thevertex.
Significant response at
the frontal area, but lessthan the vertex area.

n=13 (52%)
increased beard
density

10%Pedal edema
10%EKG changes

MullerRamos P.,et al.
2019
(24)

FPHL

1mg dailyfor 24weeks
vs.
5% topicalsolutiondaily

Sinclair R.
2016
(35)

Monilethrix0.25mg to
0.5mg
1 at 0.25mg

n=52 (52F,
0M)
5% TM n=26
Avg Age=47.3
OM n=26
Avg Age=40.6

Total hair density
increasedby 12% in OM and 7.2%
in TM
No significant difference
between them (p=0.10).
OM provides
improvement of FPHL
that does not differ from
TM. With a safe profile
and well tolerated
adverse effects

n=2 (2F, 0M)
35 y/o and 40
y/oPatient 1: Hair growthwith reduced breakage
and increased hairvolume/length.
Maintained through 2
years of follow up.
Patient 2: Decreased
shedding with 0.25mg,
improved hair density
when dosage increased
to 0.5mg. Maintained
through 18 months offollow up.

Hypertrichosis:-OM=27%-TM=4%
Edema:-OM: 4%-TM: 0%
Scalp pruritus:-OM:0%-TM:19%Mean hear rate:-OM= increaseby 6.5%-TM= no change
No difference inmean bloodpressure
between groups
No reported
adverse effects

Sinclair R.
2017
(21)

FPHL

Once daily
capsulecontaining
0.25mgminoxidil
and 25mg
spironolactone.

n=100 (100F,
0M)
Average age=
48.44 y/oBaseline Sinclair hair loss
severity score=2.79
Baseline hair shedding
score=4.82
Reduction in hair loss
severity score:
0.1 at 3 months
0.85 at 6 months
1.1 at 9 months
1.3 at 12 months
Reduction in hair
shedding score:
1.1 at 3 months
2.3 at 6 months
2.7 at 9 months
2.6 at 12 months

WambierC., et al.
2019
(32)

Alopecia
areataTofacitinib
5mg 2x dailyOr
10mg 2xdaily
OM 2.5mg
daily forwomen
OM 2.5mg
twice daily
for menn=12 (7F, 5M)

Low-dose oral minoxidil
is well tolerated and areasonable alternative to
topical minoxidil.
n=8 (67%) achieved >75%
scalp regrowthn=4 (33%) achieved 11%75% scalp regrowth
Median baseline SALT
score=99.5%
Median final SALT
score=6.5%
Combination tofacitinib
and OM may be more
efficacious thantofacitinib
Monotherapy.

n=4 facial
hypertrichosis
n=2 postural
hypotension
n=2 urticaria(likely due tospironolactone)
Avg decrease of
4.52mmHg insystolic bloodpressure and6.48mmHg in
diastolic.

n=6 (50%)
hypertrichosis
n=2 (17%) acne
No reported BPchanges,
peripheral
edema, or
symptoms ofhypotension.

Yang X.,
Thai K.
2015(36)

Permanentchemotherapy
inducedalopecia

OM 1mgdaily

n=1F
Age=39 y/oSubjective increase inhair growth at 6 weeks.
After 1 year the patient
regrew significant
amounts of hair.
Significant decreases intelogen follicles and areversal of follicle
miniaturization

None

Rodrigues-BarataR., et al.
2020
(20)

FPHL

0.25mg-2mg n=148 (148F,
daily
0M)

30 patients (20.3%) had
stabilization of hair loss.

n=25
hypertrichosis*125 patients
receivedconcomitanttherapies.
Including:-dutasteride-Mesotherapy
dutasteride-TM 5%-PRP-finasteride-flutamide-bicalutamide-cyproterone
acetate-LLLT-Latanoprost

118 patients (79.7%) had
clinical improvement (95
had slight improvement,
23 had marked
improvement)

n=2 tachycardia

OM may be an effective
and safe therapy for FPHL

n=1 peripheral
edemaJha A., et
al.
2020
(23)

AGA

1.25mgn=32 (0F,32M)
18-45 years

14/32 patients
experienced marked
improvement. 13/32
experienced mild
improvement on global
assessment.

n=1 peripheral
edema
n=1
hypertrichosis

25/32 patients
experienced statisticallysignificant improvementin average total hairdensity per unit area, andhair shaft diameter.

SinclairR., et al.
2020
(30)

AGA

0.45mgdaily(sublingual)n=64 (31F,
33M)
Mean age of
50.92 years

1.25 mg/day can be usedin male AGA, although
2.5-5 mg/day may benecessary if response issuboptimal after 6
months of treatment.
Male and Female
patients had mean
reduction of Sinclair
Stage, and Sinclair hair
shedding score.
Male patients had mean
improvement of
Investigator Global
Assessment.
Sublingual minoxidil at adose of 0.45mg daily waseffective and had an
acceptablesafety profile

n=8
hypertrichosis
n=5 posturaldizziness
n=2 peripheraledema
Avg BP at startof study:
126.27/76.69
Avg BP after 12months of OM
use:
121.85/77.46