The use of minoxidil and alopecia
Minoxidil is the only approved treatment against androgenetic alopecia and the only one approved together with finasteride for the treatment of male androgenetic alopecia.
We can say that it is the "classic treatment", since it has been used for more than 20 years in millions of men and women with alopecia throughout the world.
This drug actually began to be used orally to treat hypertension, since it dilates the blood vessels, thus improving the level of blood pressure. Interestingly, many patients had an "interesting" adverse effect: a marked increase in hair when taking the drug , so it was thought that it could be useful in alopecia.
After carrying out the relevant studies, it was found that its administration by topical route (in the form of liquid, spray or foam) was effective and safe to treat some forms of alopecia.
Some of the doubts that have arisen about minoxidil and alopecia
- What types of alopecia can be treated with minoxidil?
The most widespread use of minoxidil is in androgenic alopecia, although it can be used as a complement in other alopecias, such as alopecia areata or even some forms of scarring alopecia.
- Why does minoxidil improve alopecia?
Its effect is not entirely well known. It is believed that several factors are involved: vasodilation, direct stimulation of follicular keratinocytes, immune effect... The follicles that are in the telogen or resting phase fall out, giving way to a new phase of anagen or longer growth, where the hairs will acquire greater follicular diameter. The resulting effect is an increase in the diameter of the follicles of approximately 30%.
- How many times a day should minoxidil be applied?
Ideally, the patient should apply it twice a day (morning and night). However, application once a day at 5% has also been shown to be very effective. Even in some patients, application at a lower concentration or even 4-5 nights a week is sufficient. “It is better to apply minoxidil at a lower concentration or less frequently than not to apply it at all.”
- Can adverse effects occur?
Minoxidil is generally well tolerated. Like any medication, minoxidil can cause side effects in a small percentage of patients, but they are usually mild local effects (irritation). This irritative effect that occurs in some people is usually due to the excipient (propylene glycol), and is less frequent if a low concentration of minoxidil is used or the excipient is modified. It can be combated with anti-dermatitis shampoos. Other rare side effects if minoxidil is used correctly would be hair growth on the face and headache.
- How much minoxidil should be applied?
The standard amount is 1 mL every 12 hours, although depending on the area of alopecia, a smaller amount may be sufficient in 1 single daily application. It is very important for the patient to know that minoxidil must be applied to the skin of the scalp for proper absorption, and to visible hair.
- When is the effect of minoxidil perceived?
The increase in capillary density begins to be perceived at 5-6 months, and is maximum at one year. In the first few months, there may be an increase in hair loss (“shedding effect”) due to the onset of action of Minoxidil , which should not alarm patients, since in a few weeks they will begin to notice the positive effect. It is very important to know that the treatment with minoxidil must be continuous (although instead of twice a day it is once or even alternate days), since otherwise the gained effect is lost and the initial capillary density is returned.