It'll take at least six months of treatment to prevent further hair loss and to start hair regrowth. Sufficient time should be dedicated to discussing psychological adaptation, treatment options and realistic treatment goals. Minoxidil (Rogaine) is the only drug which is FDA-approved to treat female pattern baldness. Oral administration of finasteride or dutasteride are contraindicated for FPHL. At the 9th World Congress for Hair Research https://www.youtube.com/watch?v=DEdcq7xPCdE Professor Rodney Sinclair presented ground breaking research on female pattern hair loss. Currently, the only FDA-approved treatment for female pattern hair loss is topical minoxidil. Nevertheless, there is a study that used 52 females with female pattern baldness, and analysed the use of minoxidil 1mg oral versus minoxidil 5% topical solution for the treatment of hair loss. Australian Journal of General Practice published by the Royal Australian College of General Practitioners, 100 Wellington Parade, East Melbourne, Victoria 3002, Australia Onset: gradual/acute Sinclair RD. Hair pull test: Evidence-based update and revision of guidelines. More studies of oral minoxidil are needed but studied to date are promising. Int J Dermatol 2018;57(1):104–09. No sides from either (still early with minoxidil) but reckon the finasteride has stabilized my hair loss and the oral minoxidil is starting to bring through some small regrowth in little hairs popping up. Table 2. While there are a number of medical reports to show that oral Minoxidil helps hair loss, and this is also our experience, the quality of evidence compared to topical Minoxidil or other hair loss medications is … Perifollicular erythema and scales, Chronic cutaneous lupus erythematosus (discoid lupus), Age: young adults Global hair thinning – evenly distributed throughout scalp The psychological distress and impaired social functioning associated with hair loss can be debilitating. There is the potential for a little pill to be the answer to female-pattern hair loss. Search online for proven, FDA-approved hair loss treatments and you’ll find two medications mentioned more than any others: finasteride, an oral hormonal treatment that blocks the key hormone responsible for hair loss, and minoxidil, a topical solution for preventing baldness. The evidence for oral minoxidil is less strong but has been used successfully in post-chemotherapy hair loss, female pattern hair loss, fragile hair disorders and alopecia areata. Minoxidil was first introduced as an oral medication for the treatment of severe and recalcitrant hypertension in the 1970s. This generates feelings of greater confusion and distress for female patients. 14:47. Sinclair RD, International Journal of Dermatol, 2018, Jan;57 (1): 104-108. Ketoconazole is an antifungal with anti-androgenic properties. Focused examination should identify the calibre of the hairs and the location of the affected areas. Oral minoxidil (5 mg daily) has been shown to be efficacious in male pattern hair loss (MPHL). Results. Spironolactone and cyproterone acetate are most commonly prescribed as they have been shown to produce regrowth in 44% of patients.4, Spironolactone is an aldosterone antagonist and is used as a potassium-sparing diuretic. Introduction. Onset: gradual Minoxidil (Rogaine) is the only drug which is FDA-approved to treat female pattern baldness. General Answers (4)ASK A DOCTOR. Common in men, Variable shedding Onset: gradual/abrupt Finasteride and minoxidil may help slow down male- and female-pattern hair loss, and in some cases may even cause lost hair … The diagnosis of FPHL is associated with underlying hypertension in women aged £35 years and coronary artery disease in women aged £50 years.7 One study found that patterned hair loss was an ind… Female pattern hair loss: A pilot study investigating combination therapy with low- dose oral minoxidil and spironolactone. In trying to find other options for women, researchers looked into whether Propecia (finasteride), an effective treatment for hair loss in men, would work for women. December 27, 2019. Do men and women need different skincare and haircare products? Interventions for female pattern hair loss. To report on a case series of women with pattern hair loss (PHL) treated with once daily minoxidil 0.25 mg and spironolactone 25 mg. Methods. See Article “The Top 10 Things You need to Know About Oral Minoxidil” REFERENCE. One hundred women with female pattern hair loss took part in the study. Factors associated with female pattern hair loss and its prevalence in Taiwanese women: A community-based survey. J Am Acad Dermatol 2008;59(4):547–66; quiz 567–68. The introduction of low-dose oral minoxidil is the key recent advancement in the management of this challenging condition. Compared to male pattern baldness that causes M-shape receding hair-line starting from the front and leaving temporal hair, female pattern baldness manifests as generalized thinning and loss of hair. DHT and testosterone both bind to the same androgen receptors, but DHT does so with more affinity, leading to increased miniaturisation.3,5,6, As alopecia is highly visible, a patient may note hair loss as the first symptom of a host of underlying or contributing medical and psychiatric conditions. Rarely with diffuse hair thinning Asked By: Lila.Frances in Indianapolis, IN. Spironolactone was added to reduce the risk of fluid retention and augment treatment response.2 Side effects in the study were seen in eight patients: two had postural hypotension that was controlled with 50 mg sodium chloride; six patients had hypertrichosis that was managed with waxing. J Am Acad Dermatol 2014;71(3):415.e1–e15. It primarily affects women post their menopausal period. Those who report excessive hair shedding may have an actual increase in hair fall, or they may instead have an increased awareness of normal hair shedding. Practice, Formerly Australian Family Physician (AFP), Approximately 49% of women will be affected by hair loss throughout their lives, with female pattern hair loss (FPHL) being the most common cause of female alopecia.1 The incidence steadily increases with age in all ethnicities, and the age-adjusted prevalence among adult Australian women of European descent is >32%.1–4 This translates to 800,000 women who suffer from moderate-to-severe FPHL.4 Alopecia is associated with significant psychological distress and reduced quality of life. How it improves hair growth is not fully understood but is probably due to increased blood flow to the hair roots. While it’s been known for a long time that using Minoxidil in oral doses of up to 100 milligrams daily stimulates hair growth, its use in female pattern hair loss has largely been limited because of concerns about potential adverse side effects, including hypertension, fluid retention and hypertrichosis. More studies of oral minoxidil are needed but studied to date are promising. It is approved in Australia for the treatment of female hirsutism. ... Off-label use of oral minoxidil is known to improve hair density in the treated patients but could be complicated by postural hypotension, fluid retention, and hypertrichosis. Associated systemic lupus erythematosus 10%, Variable shedding [Epub ahead of print] PubMed … Association of androgenetic alopecia with mortality from diabetes mellitus and heart disease. Female pattern hair loss increases as women age with over 55% of women experiencing minor hair loss. Is this appointment for? It is an antihypertensive vasodilator . Hair thinning, wider midline part of the crown, no bare patches, occipital region spared, Age: adults Oral minoxidil is a medication that was initially developed in the 1950’s and was approved by the FDA for the treatment of hypertension in 1979. Introduction. Background: It has not been conclusively established that female pattern hair loss (FPHL) is either due to androgens or responsive to oral antiandrogen therapy. Female pattern hair loss with Christmas tree pattern, Generalised and rapid shedding with global hair thinning is unusual and points to other causes such as hyperadrenalism, medication exposure, major stressors or change in hair care practices.1,3,6,10,11 Hair loss over the temporal region is uncommon in FPHL, compared with male pattern alopecia. doi: 10.1016/j.ijwd.2017.01.001. Caused by a variety of unavoidable conditions, FPHL can be quite troublesome for women as the thinning of hair is very visible and can cause confidence issues. With over 20% of women experiencing moderate to severe hair loss, this medical condition is more prevalent than you may think. Atanaskova Mesinkovska N, Bergfeld WF. doi: 10.1016/j.jaad.2012.09.046. Female pattern hair loss (FPHL) is the most common form of alopecia in women. Professor Sinclair noted that, “we know that the combination of Spironolactone and topical Minoxidil has a beneficial effect in hair regrowth. However, there can be benefit with other types of hair loss too including telogen effluvium, traction alopecia and loose anagen syndrome. Begins at the vertex with bald patches Yes. With the advent of new stronger topical treatments, oral Minoxidil is no longer a great choice for pattern baldness and has not been recommended by Ashley and Martin doctors since 1995. Mubki T, Rudnicka L, Olszewska M, Shapiro J. History should include age of menarche; menstrual cycle details; whether menopause has occured and, if so, at which age; use of hormonal contraception; fertility concerns and any previous gynaecological surgery.1,3,5 A discussion of pregnancy plans is necessary as some treatments are teratogenic.1, Fifty-four per cent of patients have a first-degree male relative of age >30 years with alopecia, and 21% have a first‑degree female relative aged >30 years with FPHL. Oral minoxidil (5mg daily) has been shown to be efficacious in male pattern hair loss (MPHL)2,3. male and female pattern hair loss and can be brought over the counter in most chemists. “5% minoxidil: Treatment for female pattern hair loss.” Skin Therapy Lett. Figure 1. In a study conducted on 52 female subjects with female pattern hair loss, it was determined that 1 mg of oral minoxidil was equally as effective as 5% topical minoxidil applied daily. In addition, oral minoxidil has also been investigated by the medical community as a potential agent for male pattern hair loss. Minoxidil was first introduced as an oral medication for the treatment of severe and recalcitrant hypertension in the 1970s. To report on a case series of women with pattern hair loss (PHL) treated with once daily minoxidil 0.25 mg and spironolactone 25 mg. Methods. It has been used off-label for FPHL with a treatment regimen of 50–200 mg daily for at least six months and shown to arrest progression in 90% of women and improve hair density in 30%.2 Common side effects are lethargy and menorrhagia, which improve after three months. Hair loss in women is often treated with a topical solution (Rogaine), some oral contraceptives, a medicated shampoo, and other drugs. Summary of counselling points and treatment options1,2,10,15, Minoxidil is a piperidinopyrimidine derivative and a vasodilator that is used orally for hypertension. Dermatomyositis, dissecting cellulitis, central centrifugal cicatricial alopecia, Laboratory testing should be considered in patients with diffuse alopecia, signs of androgen excess and early-onset FPHL. in the treatment of female pattern hair loss. Onset: abrupt – triggered by iron deficiency, thyroid dysfunction, general anaesthesia, childbirth and medications, Prominent shedding ... whereas prosthetic hair transplantation and oral administration of minoxidil should not be performed. doi: 10.1016/j.jaad.2014.04.070. It’s available as a 2 percent solution, a 5 percent solution, or a foam that can applied to the scalp. The topical one is great cuz you got regrowth where you would like to get it, In contrary with Loniten be ready have more pilosity, in my case, my beard, eyebrows, eyeleash and my facial pilosity generally grewth 2 times more, with 5mg a day you got less pilosity growth but as hair growth, so you choose. Oral minoxidil was originally used for treating high blood pressure, but patients and health care providers noticed hair growth was a side effect of treatment.This led to the development of topical (solution applied to the skin) minoxidil for the … Su LH, Chen LS, Chen HH. McDonald KA, Shelley AJ, Colantonio S, Beecker J. There were no reports of hyperkalaemia or laboratory function abnormality.2, Androgen receptor blockers target androgen conversion and subsequent binding onto hair follicle target receptors in alopecia. However, certain oral, topical and other medications and methods can be used to help regrow hair in women with this condition. Minoxidil can stimulate all hair, and the topical formulation is currently the only drug approved for treatment of female pattern hair loss. As a result, the makers of minoxidil submitted trials to the FDA to be the first treatment approved for male and female pattern hair loss, in 1988, the FDA approved minoxidil as the first drug to treat hair loss, and the rest is history. Women normally shed between 50 and 150 hairs per day. Epub 2017 Dec 12. Sensation of tension that is only relieved by pulling hair Low-dose oral minoxidil (0.25 mg daily) has been successfully used in combination with spironolactone in the treatment of female pattern hair loss (FPHL). Oral Minoxidil for Pattern Hair Loss? FPHL is a common, non-scarring alopecia that affects women of all ages and carries significant psychological morbidity. … Should men buy different shampoos? Beach RA. Irregularly shaped patches of reduced hair density with irregular borders, Other common non-scarring alopecia differentials: A total of 100 women were included in this … Fasting lipid profile Alternatives to Oral Minoxidil At Ashley and Martin, we know that not all hair loss treatments are right for every person. Now I will talk about the bad side of Oral minoxidil. Why Oral Minoxidil Is Not Recommended As A Hair Loss Drug. In alopecia, it acts by reducing the levels of total testosterone and completely blocking androgen receptor activity in target tissues. JAMA Dermatol 2013;149(5):601–06. Laboratory tests in hair loss evaluation1,3,10,11, Menstrual irregularity, dysmenorrhea, severe acne and marked hirsutism, (Endocrine screen) Australian Gupta, AK, Foley KA. Int J Dermatol. If temporal thinning was the first symptom, telogen effluvium, frontal fibrosing alopecia, tractional alopecia and hypothyroidism should be considered.6 Symptoms of scalp pruritus, burning and pain point to another diagnosis (Table 1).6, Table 1. See Article “The Top 10 Things You need to Know About Oral Minoxidil” REFERENCE. Scalp itch and burning This undesired process is known as hair follicle miniaturisation.1,3,5,6 The trigger for miniaturisation remains unclear but is postulated to be a combination of genetic predisposition, androgen influence and other not yet elucidated factors. doi: 10.1016/j.det.2010.03.011. Parietal area with bare patches But, if they’re literally scratching their […], Do men and women need different skincare and haircare products?June 16, 2020, Flattening the lice curve: Our chance to suppress nitsMay 28, 2020, COVID-19 Survival Guide – Key things to know in case you get sickMarch 26, 2020. Case series of oral minoxidil for androgenetic and traction alopecia: Tolerability & the five C’s of oral therapy. Female pattern hair loss update: Diagnosis and treatment. The Hair Loss Show 10,928 views. More prevalent in Caucasian women Female pattern hair loss with Christmas tree pattern Generalised and rapid shedding with global hair thinning is unusual and points to other causes such as hyperadrenalism, medication exposure, major stressors or change in hair care practices. DOWNLOAD ORAL MINOXIDIL HANDOUT. Female pattern alopecia: Current perspectives. doi: 10.2147/IJWH.S49337. Objective: To report on a case series of women with pattern hair loss (PHL) treated with once daily minoxidil 0.25 mg and spironolactone 25 mg. Methods: Women newly diagnosed with a Sinclair stage 2-5 PHL were scored for hair shedding and hair density before and after 12 months of treatment with oral … For more on hair loss: Women tend to use the 2% topical formulation to regrow thinning hair. It has also been shown to be able to produce hair regrowth in some women with female pattern hair loss. Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. Although topical minoxidil has become a mainstay treatment in hair loss, there is a recent study showing that low doses of oral minoxidil may be a helpful adjunct treatment for female-pattern hair loss (1). This is a pregnancy category D medication.5,14, Cyproterone acetate directly blocks androgen receptor activity and decreases testosterone levels by suppressing luteinising hormone and follicle stimulating hormone release. 9) Minoxidil: mechanisms of action on hair growth. Su LH, Chen LS, Lin SC, Chen HH. Are there any other treatment options available? Minoxidil, the active ingredient in Rogaine, and many other products, is usually the first-line treatment option for female pattern hair loss. 50% of patients also have lichen planus, Variable shedding hair growth in male and female pattern hair loss. A 53-year-old woman with clinical evidence of female pattern hair loss and histological evidence of androgenetic alopecia was initially treated with the oral antiandrogen spironolactone 200 mg daily. Androgens exert their effect on hair via circulating levels of testosterone, which is produced in females by the ovaries and adrenal glands. high blood pressure) and prevent complications such as kidney issues, strokes and heart attacks. doi: 10.1016/j.jaad.2016.10.002. Onset: gradual/abrupt Minoxidil Response Testing in Females With Female Pattern Hair Loss The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. General observations for body habitus, acne, hirsutism and acanthosis nigricans should be made. 1 Coincidentally, physicians observed hair regrowth and generalized hypertrichosis in balding patients, which led to the development of a topical minoxidil formulation for treating androgenetic alopecia (AGA) first in male and then in female individuals. It may take a few more months to tell whether the treatment is working for you. Br J Dermatol 2010;162(4):786–89. Oral minoxidil for hair loss At Salford Royal, patients are considered eligible for oral minoxidil treatment if their hair loss has not responded to topical minoxidil or if these products are not tolerated. Female pattern hair loss (FPHL), also known as androgenetic alopecia (AGA), is a hair loss that affects more than two-thirds of postmenopausal women. doi: 10.1001/jamadermatol.2013.130. Women newly diagnosed with a Sinclair stage 2–5 PHL were scored for hair shedding and hair density before and after 12 months of treatment with oral minoxidil 0.25 mg and spironolactone 25 mg. In recent years, there has been a renewed interest in utilising oral minoxidil at low dose to treat androgenetic alopecia (pattern hair loss). Effective dosages are 100 mg daily in postmenopausal women, and 50 mg for 10 days in premenopausal women for three months.4 In one study of 80 patients, cyproterone produced similar results to 200 mg daily of spironolactone.5 This is a pregnancy category X medication as it may cause feminisation of the male fetus.14 Side effects include weight gain, breast tenderness and decreased libido.5, Although 5-alpha reductase inhibitors have revolutionised the treatment of male pattern alopecia, their use in FPHL is limited because of lack of efficacy and the teratogenic potential (pregnancy category X).5 A finasteride dose of 1 mg daily was no better than placebo in treating FPHL in postmenopausal women and was only mildly efficacious in premenopausal women who had associated hyperandrogenism.14,15. Results The hair loss treatments can slow, reduce and stimulate partial hair regrowth. Female pattern hair loss: A pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. Int J Womens Health 2013;5:541–56. Hair loss is usually diffuse and affects the top of the scalp. 1) Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. The test is positive when more than three hairs can be pulled away.12. A combination of low dose oral minoxidil (0.25 mg daily) and spironolactone (25 mg daily) has been shown to significantly improve hair growth, reduce shedding and improve hair density. Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. So sure, it is science, but it could be a little magic too. Blood pressure monitoring, Marked temporal region thinning and lateral eyebrow loss, Thyroid function test, thyroid antibodies, Systemic lupus erythematosus, autoimmune disorders, Erythrocyte sedimentation rate, rheumatoid factor, autoantibody tests, Rapid and diffuse hair shedding in a sexually active individual, Non-treponemal and treponemal antigen testing, Scalp fungal scrapings for culture and microscopy, Rapid and diffuse hair shedding, low body mass index, Key points of counselling and non-pharmacological treatment options are outlined in Figure 2. Prolactin level Jimenez JJ, Wikramanayake TC, et al. Scaly papules, erythematous and violaceous discolouration of scales, follicular plugging and telangiectasia, Age: young and middle-aged adults Bare patches of scalp Evaluation and diagnosis of the hair loss patient: Part I. Sinclair RD. In this article, we will be going over the efficacy and safety of oral minoxidil for the treatment of hair loss. The aim of this work was to evaluate the safety and possible trichogenic effects of ketoconazole in FPHL. doi: 10.1002/14651858.CD007628.pub4. It was first noticed to improve hair loss in men in 1980. Onset: gradual Often patients discontinue minoxidil after several months if they haven’t noticed increased growth. Minoxidil’s exact mechanism of action is complicated. Recommended tests and rationale are outlined in Table 3. The degree of alopecia will return to the level that would have occurred if there were no treatment.2, Oral minoxidil 0.25 mg daily in combination with spironolactone 25 mg was shown to be effective in reducing hair loss severity and hair shedding score at six months and 12 months in an Australian prospective study with 100 women with mild-to-moderate FPHL. Background: It has not been conclusively established that female pattern hair loss (FPHL) is either due to androgens or responsive to oral antiandrogen therapy. Personal or family autoimmune history, Prominent shedding These include iron deficiency, infection, thyroid dysfunction and nutritional deficiencies.3,11 Occupational history and exposure to, or ingestion of, toxic chemicals should be elicited.10, A detailed gynaecological history is necessary to rule out hyperandrogenism, polycystic ovarian syndrome or a virilising tumour as underlying diagnoses. Two patients terminated oral minoxidil because of urticaria. Oral minoxidil is mainly used for male and female pattern hair loss. In women, female pattern hair loss (FPHL) is the most common form of hair loss. 2) Effectiveness and safety of low-dose oral minoxidil in male androgenetic alopecia. There are a number of reported treatments for hair loss. So sure, it is science, but it could be a little magic too. ... Table 2: Summary of studies AGA= Androgenetic Alopecia F= Female, M= Male, y/o= years old, OM= Oral … Very few people use oral Minoxidil to treat male androgenetic alopecia or female pattern hair loss. Key features in history taking and examination for detection of underlying systemic illnesses1,6,10, Underlying systemic diseases that may present with alopecia, Hyperandrogenism +/– associated metabolic syndrome, Red flags on history taking for underlying systemic illnesses, Menstrual irregularity, fertility difficulty, Examination findings suggestive of underlying disorders, SLE: isolated parietal alopecia, scarring alopecia (violaceous papules, follicular erythema), associated cutaneous malar rash, arthralgia, Thyroid dysfunction: temporal region alopecia, lateral eyebrow hair-loss, Trichotillomania: broken hair shafts of variable length, diffuse and patchy hair loss, Endocrinopathy: acanthosis nigricans, hirsutism, truncal acne (especially nodulocystic), high body mass index, Nutritional deficiency: conjunctival pallor, glossitis, muscle wasting, After diagnosing FPHL, concurrent medical illnesses that exacerbate alopecia should be ruled out to improve overall outcome.