A poster highlighting the results of an international consensus on hair removal was awarded fourth place at the 2024 American Academy of Dermatology Annual Meeting for efforts to support patients, colleagues, and communities.
“Initiation and Monitoring of Low-Dose Oral Minoxidil for Hair Loss (LOMI): Modified Delphi Consensus of Experts” brings together dermatologists with experience and expertise in research, clinical practice, and professional societies to discuss low-dose oral minoxidil We reviewed the current literature on the use of . 1 Topical minoxidil is currently approved for androgenetic alopecia and is used off-label for other hair loss diseases. Lower doses of minoxidil are commonly used when the drug is ineffective, logistically difficult, or tolerable. Because there are limited large-scale trials examining its use, the contributing authors sought to develop guidelines based on expert consensus.
“LDOM is more expensive, more logistically difficult, has plateaued in efficacy, produces unwanted product residue and skin irritation, or is used to treat inflammatory processes (i.e., eczema, psoriasis, etc.). The authors shared the following information: Consensus results. Efficacy noted by consensus is typically demonstrated 3 to 6 months after initiation of treatment, with daily dose ranges from 0.625 to 2.5 mg for adolescent (12 to 17 year old) females to 0.625 to 2.5 mg for adult females. 0.625 to 5 mg per day for adult women, and 1.25 mg to 5 mg per day for adult women. For both young men and adult men.
Consensus recommends specialist consultation only if there are potential contraindications (drug hypersensitivity, significant drug-drug interactions, history of cardiac complications, pheochromocytoma, renal impairment, dialysis, pregnancy/lactation) I’m doing it. Consensus recommends monitoring for side effects at the beginning of treatment; When the dose is increased because symptoms such as dizziness or chest pain may occur.
According to a consensus report, patients with androgenetic alopecia, age-related hair thinning, alopecia areata, telogen effluvium, traction alopecia, persistent chemotherapy-induced alopecia, and endocrine therapy-induced alopecia , a direct effect of LDOM is likely to be seen. The results also have a supportive effect on patients with lichen planopilaris, frontal fibrosing alopecia, central centrifugal alopecia, and patterned distribution fibrosing alopecia. was shown.
Dermatology Times spoke with lead researcher Jennifer Hu, MD, clinical assistant professor of dermatology and director of the Hair Disorders Clinic at the University of California, San Francisco, about the poster and the group’s important work.
Dermatology Times: Tell us about your research and what inspired you and your colleagues to address this issue.
Jennifer Hu, MD: Hair loss is very common, has a significant impact on patients’ lives, and can occur secondary to a variety of causes.
Topical minoxidil is an FDA-approved over-the-counter medication used to treat androgenetic alopecia (AGA), the most common hair loss condition. It is also used off-label for many other types of hair loss. Topical minoxidil is safe and effective, but patient adherence may be low. Patients often find it difficult to apply topical minoxidil. They report that it leaves an unwanted residue and can have a drying effect on hair and skin. Topical minoxidil may also cause irritating or allergic contact reactions.
All these factors have led to the increasing popularity of low-dose oral minoxidil (LDOM) in the treatment of hair loss. Oral minoxidil is a peripheral vasodilator that was originally approved by the FDA in the 1970s for the treatment of severe, refractory hypertension. Interestingly, a significant side effect of oral minoxidil is hirsutism, which led to the investigation of topical minoxidil as a hair growth agent.
Although oral minoxidil is no longer the first-line antihypertensive drug due to the potential for adverse cardiovascular effects at antihypertensive doses (10 mg to 40 mg per day), the use of LDOM at doses in the following ranges is recommended. An increasing number of case reports and case series are being recorded. A safe and effective option for many types of hair loss in men and women, including AGA, age-related hair thinning, traction alopecia, and alopecia areata in doses of 0.25 mg to 5 mg per day.
This literature correlates with a parallel increase in LDOM prescriptions by dermatologists in recent years and a surge in oral minoxidil prescriptions obtained in the digital consumer telemedicine healthcare sector. Given this, and the current lack of large-scale trials on this topic, our research group aims to maximize hair growth and minimize potential adverse cardiovascular effects. We identified a strong need for expert-based guidelines for prescribing and monitoring LDOM use in hair loss patients. effect.
We reviewed the existing pharmacological data on oral minoxidil and clinical reports of LDOM for hair loss. We then recruited a panel of dermatologists with hair loss expertise and engaged in a four-round modified Delphi consensus process to develop best practice guidelines for the use of LDOM in hair loss patients.
Dermatology Times: What are some of the challenges when dealing with hair loss in patients?
Jennifer Hu, MD: As we all know, hair loss is a very personal thing that affects our sense of self and our sense of being part of a community. We use our hair to express everything about ourselves: our personal style, gender, sexuality, cultural and ethnic traditions, religious and political affiliations.
Addressing the needs of hair loss patients requires a comprehensive approach and partnerships within and outside of medicine. When it comes to hair loss, treating the whole patient often requires a combination of basic science partners, medical colleagues from other specialties, pharmacy experts, insurance professionals, patient advocacy groups, industry representatives, etc. , you will need to work with a diverse group of collaborators. and state and federal legislators.
“Meeting the needs of hair loss patients requires a comprehensive approach and partnerships within and outside of medicine.”
Dermatology Times: What do you think the future holds for hair loss treatments?
Jennifer Hu, MD: We are very excited about recent advances in our understanding of hair follicle immunology and the various biochemical signals that influence the hair cycle. Although much of this research has focused on the specific disease condition of alopecia areata, these basic concepts extend beyond a single disease and include other types of non-scarring alopecia and scarring. We hope this will lead to a more sophisticated approach to sexual alopecia.
Dermatology Times: What would you like your dermatology colleagues to know about your award-winning poster and hair loss treatments?
Jennifer Hu, MD: We hope these guidelines will be helpful to colleagues who are interested in using LDOM to treat hair loss in adult and adolescent patient populations. It is anticipated that these recommendations will be updated as additional evidence-based data emerges. We also encourage our pediatric dermatology colleagues to investigate best practices for LDOM in pediatric patients.
1. Akiska YM, Mirmirani P, Roseborough I, et al. Initiation and monitoring of low-dose oral minoxidil (LOMI) for hair loss: modified eDelphi consensus of experts. Presented at the 2024 AAD Annual Meeting. March 9, 2024. San Diego, California. Accessed March 8, 2024. https://aad-eposters.s3.amazonaws.com/AM2024/poster/50804/Low-Dose+Oral+Minoxyil+Initiation+and+Monitoring+LOMI+For+Hair+Loss+A+Fixed+Delphi+Consensus+of +Experts.pdf.
2. Rajab F. Low-dose oral minoxidil for hair growth. Dermatology Times. 2022; 43(11):38-39.
