Topical Minoxidil

Minoxidil was the first FDA approved medication for treating hereditary hair loss. Originally used as an oral medication for treating hypertension, patients on minoxidil frequently complained of excessive hair growth on the scalp and face. Topical minoxidil was approved by the FDA in 1988 after studies showed it was effective for treating male pattern hair loss. Since that time both females and males suffering from inherited hair loss have used minoxidil with great success.

Minoxidil for Men:

Presently, minoxidil is FDA-approved for men in a Rogaine® 5% solution and foam. The solution is applied with a dropper but can be messy and difficult to apply. Many prefer the less greasy foam formulation. Patients who are highly motivated can apply the product twice daily. It is preferred to use on a dry scalp (so the product is not diluted) but some men prefer to apply it to towel-dried hair after showering. The key is to find a routine that works for you and stick with it! Consistent use for a minimum of 6-12 months is necessary in order to see results.

Minoxidil for Women:

5% minoxidil foam is now FDA approved for once-daily treatment of hair loss in women. This occurred after one study published in the Journal of the American Academy of Dermatology showed that the 5% minoxidil formulation applied once daily is just as effective in women as the 2% applied twice daily. Women who don't wash their hair often may prefer to apply the 5% solution once daily with a dropper. That way they can wash and style their hair normally in the morning. It is not essential to wash the hair daily, but a slight residue may build up on the scalp after a few days’ use.

Are there any women who should NOT use the 5% Rogaine? Yes. There are two groups who should be cautious with the 5% formulation:

hypertrichosis-33-jpg 1) Women with unwanted facial hair. If you already have unwanted facial hair, there is a chance that it may become thicker or darker with use of 5% minoxidil. This is not from the medication running down the face but rather from the systemic absorption of the minoxidil. A safe approach would be to start with the 2% once daily at night. Alternatively, you may start with the 5% and consider various hair removal treatment strategies, such as Vaniqa® cream, laser hair removal, depilatories, or electrolysis if you do get additional unwanted facial hair.

2) Women with severe migraine headaches. Because minoxidil is a vasodilator it may trigger headaches or light-headedness. Starting with 2% minoxidil is a better option.

FAQ about minoxidil:

“Isn’t it true that you have to use it forever or all your hair will fall out?”

Yes and No. Minoxidil must be used consistently in order to see long lasting results. That being said, if you miss a few days, or take a week off while on vacation, it won’t be the end of the world. The benefits are similar to brushing your teeth or taking blood pressure medicine; you must do these things in an open-ended fashion. But there is nothing compulsory about this medication. You can stop it at any time. Yes, you may take some steps back, but you will certainly not lose the hair you had up until the point you started the medication. Many patients tell us they ‘cycle on’ and ‘cycle off’ of the medication frequently when they need breaks or are just tired of using it.

“Can I use this on the front of my scalp?”

The Rogaine packaging says “only for use in the vertex (crown) of the scalp.” The reason for this is related to FDA allowance of packaging claims based on the data submitted in clinical trials. Subsequent data has shown that minoxidil indeed works very well on the frontal scalp. It can be confidently used on the frontal scalp with the same degree of success.

"I don't like the dropper that comes with the solution. What can I use instead?"

Many people prefer to pour the solution into a travel hair spray bottle (available for $1-3 at any pharmacy or dollar store). This way they can quickly spritz the scalp whenever they remember. Take another minute to massage the medicine it to help it penetrate the scalp. This little trick is also great for college students who don't want their roommates to know they are using Rogaine!

“Can I use the generic of Rogaine?”

Absolutely. There are a number of very good generic equivalents, manufactured by various pharmacy chains and big box chain stores. So long as they contain minoxidil as the active ingredient they should be just as effective. However if you try a generic for the first 6 months and have no results, then it may be worth switching to the brand name before you give up altogether.

“Should Rogaine make my scalp itch?”

No. Itching suggests that you may have a contact dermatitis to one or more of the ingredients. If you develop itching, follow the instructions below.

1. Discontinue minoxidil and consult your physician. You may be prescribed topical or oral steroids to help relieve symptoms.

2. Once your scalp is clear of itching and rash, proceed with patch testing as described. Apply a small amount of Rogaine foam to the inside of your elbow (figure). This will serve as a ‘patch test’ to see if you are also allergic to the foam formulation. If you still have an itchy reaction, then it is likely that you are indeed allergic to the minoxidil itself, which is in both the solution and the foam. This means you cannot use this product. However, if you have no reaction then you were probably reacting to propylene glycol, which is a preservative in the solution (not the foam). You may be able to (cautiously) restart the Rogaine foam under your doctor’s supervision.

“What are these minoxidil substitutes? Do they really work?”

There are a number of products with similarity to minoxidil claiming better tolerability and in some cases even better absorption. They go by the trade names kopexil (trade name Aminexil) or nonoxidil. Kopexil is not approved for use in the United States and there is no data showing its efficacy in treating hair loss. There is also no data demonstrating the efficacy of nanoxidil in treating hair loss. While reports claim that these products are 'better tolerated' the culprit for itchy scalp is usually propylene glycol (a preservative used in many hair care products) not the minoxidil itself.