Androgenetic alopecia is characterized by the progressive shrinking of hair follicles and a shortened growth phase, leading to noticeable hair thinning and loss. A recent breakthrough study published in the Journal of JAMA Dermatology reported that the efficacy of low-dose oral minoxidil (5 mg per day) is comparable to that of topical minoxidil, 5%, in men with androgenetic alopecia. The study has suggested that oral options may be suitable for patients who favor oral therapy or experience intolerance to topical treatments.
The double-blind, placebo-controlled randomized clinical trial conducted by Penha et al. involved 90 male participants diagnosed with AGA, with 68 completing the study. Patients were randomly assigned to receive either once-daily oral minoxidil at 5 mg along with twice-daily topical placebo solution or twice-daily topical minoxidil at 5% concentration along with once-daily oral placebo. For 24 weeks, researchers assessed changes in terminal hair density in both the frontal and vertex regions of the scalp. Terminal hairs, defined as those with a diameter of at least 0.06 mm, were blindly counted to determine hair density. Surprisingly, the mean change from baseline in both terminal and total hair density was found to be similar in both groups at the end of the study period.
In terms of specific regions of the scalp, the mean change in terminal hair density in the frontal area was 3.1 hairs per cm2, while in the vertex area, it was 23.4 hairs per cm2. Similarly, the mean change in total hair density was 2.6 hairs per cm2 in the frontal area and 5.5 hairs per cm2 in the vertex area. The oral minoxidil group exhibited a higher increase in terminal hair density in the vertex area compared to the topical group, with a 27.1% difference. Additionally, more patients in the oral treatment group experienced clinical improvement in the vertex area compared to the topical group.
Adverse events associated with both treatments were mild, with only one patient in the oral minoxidil group discontinuing treatment due to a headache. The most common adverse event reported in both groups was hypertrichosis, a condition characterized by excessive hair growth.
Despite the overall comparable efficacy between oral and topical minoxidil, the study findings suggest that low-dose oral minoxidil may offer a viable alternative for patients who prefer oral therapy or are intolerant to topical treatment. However, it is important to note that oral minoxidil did not demonstrate superiority over topical minoxidil in the treatment of male AGA after the 24-week study period.
The study findings suggest that low-dose oral minoxidil could be a viable option for patients who either prefer oral therapy or experience intolerance to topical treatments for male androgenetic alopecia. Notably, this oral alternative has demonstrated promising results with favorable tolerability and potential benefits in targeted scalp regions. Nevertheless, further research is warranted to thoroughly investigate its long-term efficacy and safety profile.
Reference
Penha MA, Miot HA, Kasprzak M, Müller Ramos P. Oral Minoxidil vs Topical Minoxidil for Male Androgenetic Alopecia: A Randomized Clinical Trial. JAMA Dermatology [Internet]. 2024 Apr 10 [cited 2024 Apr 20]; Available from: https://doi.org/10.1001/jamadermatol.2024.0284