What is the role of minoxidil in the treatment of androgenetic alopecia?

Updated: Feb 12, 2018
  • Author: Robert P Feinstein, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Although the method of action is essentially unknown, minoxidil appears to lengthen the duration of the anagen phase, and it may increase the blood supply to the follicle. [27] Regrowth is more pronounced at the vertex than in the frontal areas and is not noted for at least 4 months. Continuing topical treatment with the drug is necessary indefinitely because discontinuation of treatment produces a rapid reversion to the pretreatment balding pattern.

Patients who respond best to this drug are those who have a recent onset of androgenetic alopecia and small areas of hair loss. The drug is marketed as a 2% or a 5% solution, with the 5% solution being somewhat more effective. A 48-week study compared the 2 strengths in men. [28] Findings indicated that 45% more regrowth occurred with the 5% compared with the 2% solution. In general, women respond better to topical minoxidil than men. The increase in effectiveness of the 5% solution was not evident for women in the FDA-controlled studies. Subsequent studies have shown at best a modest advantage to the higher concentration in women. In addition, the occurrence of facial hair growth appears to be increased with the use of the higher-concentration formulation.

Central chorioretinopathy has been associated with the use of minoxidil 2% for androgenetic alopecia. A 37-year-old man developed this adverse effect consisting of a positive elative scotoma, metamorphopsia, and impaired dark adaptation of the right eye after 8 months use of minoxidil for androgenetic alopecia. However, 1 month after cessation of the drug, normal findings were found upon reexamination. [29]


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