|Minoxidil was first marketed in the late 1970s as an oral medication to treat high blood pressure. It reduces blood pressure by dilating blood vessels. One of the side effects that patients noticed was increased hair growth and the maker soon realized that Minoxidil had benefits as a hair loss treatment. The drug was approved by the FDA as one of the first hair loss treatments that could claim to grow hair. Rogaine was the first product that had Minoxidil as the active ingredient. Minoxidil has been shown to prolong
the Anagen phase of hair growth.
|Many find that Minoxidil will re-grow hair to some extent. However the quality and thickness of the hair varies from patient to patient. The longer that the hair has been dormant the less likely that Minoxidil will re-start the follicle growing.
It has been found to work even better by combining it with other drugs that increase the absorption.
In sum, several studies have shown that approx. 15% will experience some sort of hair regrowth, while 50% have their hair loss delayed and approx. 35% will continue to loose hair.
Minoxidil is made by several companies in both 2% and 5% strengths and even higher strengths, up to 18%.
It is supplied in liquid or foam varieties with many reporting that the foam is more convenient.
|Significant Side Effects
When applied topically, Rogaine (minoxidil) has been shown to stimulate hair growth in males and females with alopecia androgenetica; however, the exact mechanism of action of Rogaine in the treatment of alopecia androgenetica is not known. The regrowth can be observed after approximately 4 or more months of use and is variable among patients. Upon discontinuation of treatment with Rogaine, new hair growth stops and restoration of pretreatment appearance may occur within 3-4 months.
Topical application of Rogaine showed no systemic effects related to absorption of minoxidil when tested in controlled clinical trials in both normotensive and untreated hypertensive patients.
Five-year follow-up of men with androgenetic alopecia treated with topicalminoxidil
Topical minoxidil solution 2% stimulates new hair growth and helps stop the loss of hair in individuals with androgenetic alopecia (AGA). Results can be variable, and historical experience suggests that higher concentrations of topicalminoxidil may enhance efficacy.
A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men
Thirty-one men with androgenetic alopecia completed 4½ to 5 years of therapy with 2% and 3% topicalminoxidil. Hair regrowth with topicalminoxidil tended to peak at 1 year with a slow decline in regrowth over subsequent years. However, at 4½ to 5 years, maintenance of nonvellus hairs beyond that seen at baseline was still evident. Topicalminoxidil appears to be effective in helping to maintain nonvellus hair growth in men with androgenetic alopecia.
The additive effects of minoxidil and retinol on human hair growth in vitro.
Minoxidil enhances hair growth by prolonging the anagen phase and induces new hair growth in androgenetic alopecia (AGA), whereas retinol significantly improves scalp skin condition and promotes hair growth. We investigated the combined effects of minoxidil and retinol on human hair growth in vitro and on cultured human dermal papilla cells (DPCs) and epidermal keratinocytes (HaCaT). The combination of minoxidil and retinol additively promoted hair growth in hair follicle organ cultures. In addition, minoxidil plus retinol more effectively elevated phosphorylated Erk, phosphorylated Akt levels, and the Bcl-2/Bax ratio than minoxidil alone in DPCs and HaCaT. We found that the significant hair shaft elongation demonstrated after minoxidil plus retinol treatment would depend on the dual kinetics associated with the activations of Erk- and Akt-dependent pathways and the prevention of apoptosis by increasing the Bcl-2/Bax ratio.
Topical minoxidil in early male pattern baldness.
One-hundred twenty-six healthy men with early male pattern baldness completed a 12-month double-blind, controlled trial of 2% and 3% topical minoxidil. Subjects were initially randomly assigned to use placebo or 2% or 3% topical minoxidil. After 4 months of study, the placebo group was crossed over to 3% topical minoxidil. Both objective measurement of hair growth by counting of vellus, terminal, and total hairs in a vertex target balding area and subjective assessment by subject and investigator were done. Treatment of subjects with topical minoxidil for 4 months resulted in a statistically significant increase in terminal hair growth in comparison with placebo therapy. In addition, subjects initially treated with placebo, when crossed over to topical minoxidil, showed a significant increase in the number of terminal hairs. No subject had a net hair loss in the target area during the study. These results indicate that topical minoxidil can increase terminal hair growth in early male pattern baldness.
Topical minoxidil therapy in hereditary androgenetic alopecia.
A randomized double-blind trial of topical minoxidil therapy was carried out on 56 patients with hereditary male pattern baldness. The subjects selected were required to have a discernible balding patch, a minimum of 2.5 cm in diameter on the vertex of the head where the hairs could be counted and photographed. Minoxidil, 1.0 mL, was applied twice a day to the scalp beginning at the balding vertex and spreading centrifugally around the scalp. Cosmetically acceptable hair growth was achieved in 18 patients (32%). The most notable indicators for regrowth of hair were the number of indeterminate hairs initially present, the duration of baldness, and the size of the balding area. No serious systemic or cutaneous side effects were noted.
Topical minoxidil for male pattern baldness.
Significant hair growth occurred in 53% of the 81 patients completing a 1 year trial of topical minoxidil. The average reduction in the diameter of the balding crown was 3.48 cm for all patients. There were no minoxidil related changes in laboratory tests during the study period. Psychosocial studies of our patients indicate that 95% assessed the effectiveness of topical minoxidil as moderate or excellent. The majority of those participating in the study thought that their personal presentation of self was of equal or greater importance than their work performance. It was concluded that topical minoxidil has the potential to improve male pattern baldness significantly without apparent risk and to be a means by which individual presentation of self may be improved.
Activation of cytoprotective prostaglandin synthase-1 by minoxidil as a possible explanation for its hair growth-stimulating effect.
Data from the literature indicate that nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin, naproxen, piroxicam, or ibuprofen, induce hair loss in vivo. These NSAIDs are well-known inhibitors of both the cytoprotective isoform of prostaglandin endoperoxide synthase-1 (PGHS-1) and of the inducible form (PGHS-2). By immunohistochemical staining, we found that PGHS-1 is the main isoform present in the dermal papilla from normal human hair follicle (either anagen or catagen), whereas PGHS-2 was only faintly and exclusively expressed in anagen dermal papilla. Thus, PGHS-1 might be the primary target of the hair growth-inhibitory effects of NSAIDs. We thus speculated that activation of PGHS-1 might be a mechanism by which minoxidil (2,4-diamino-6-piperidinopyrimidine-3-oxyde) stimulates hair growth in vivo. We demonstrate here that minoxidil is a potent activator of purified PGHS-1 (AC50 = 80 microM), as assayed by oxygen consumption and PGE2 production. This activation was also evidenced by increased PGE2 production by BALB/c 3T3 fibroblasts and by human dermal papilla fibroblasts in culture. Our findings suggest that minoxidil and its derivatives may have a cytoprotective activity in vivo and that more potent second-generation hair growth-promoting drugs might be designed, based on this mechanism.
Finasteride in the treatment of men with frontal male pattern hair loss.
Finasteride, a specific inhibitor of type II 5alpha-reductase, decreases serum and scalp dihydrotestosterone and has been shown to be effective in men with vertex male pattern hair loss.
This study evaluated the efficacy of finasteride 1 mg/day in men with frontal (anterior/mid) scalp hair thinning.
This was a 1-year, double-blind, placebo-controlled study followed by a 1-year open extension. Efficacy was assessed by hair counts (1 cm2 circular area), patient and investigator assessments, and global photographic review.
There was a significant increase in hair count in the frontal scalp of finasteride-treated patients (P < .001), as well as significant improvements in patient, investigator, and global photographic assessments. Efficacy was maintained or improved throughout the second year of the study. Finasteride was generally well tolerated.
In men with hair loss in the anterior/mid area of the scalp, finasteride 1 mg/day slowed hair loss and increased hair growth.