Optimal use of topical minoxidil in management of female pattern hair loss in India: an expert opinion
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20220503Keywords:
Minoxidil, FPHL, Androgenetic alopecia, TreatmentAbstract
Female pattern hair loss (FPHL) is a common cause of hair loss and is associated with a reduction in quality of life and psychological morbidity. It is characterised by nonscarring progressive thinning of hair with gradual reduction in the number of hairs, with prevalence increasing with advancing age. A differential diagnosis of FPHL includes conditions like chronic telogen effluvium, diffuse alopecia areata, and some cases of scarring alopecia such as frontal fibrosing alopecia. A comprehensive history and thorough clinical examination are essential in establishing the diagnosis of FPHL. Additionally, dermoscopy is a valuable tool for appropriate diagnosis, specifically in early stages of the disease. Due to the chronic course and progressive nature of FPHL, long-term management is essential for sustained effects. Medical treatment with minoxidil remains the mainstay treatment for FPHL. Other therapeutic modalities include topical therapies like biomimetic peptides, systemic therapies like oral anti-androgen drugs such as finasteride and spironolactone as well as oral minoxidil in selected cases. Dermatosurgical procedures like platelet rich plasma, microneedling, low level laser and hair transplantation have been used. The role of diet has also been debated. The current article provides an overview on the optimal use of topical minoxidil for management of FPHL in Indian clinical practice.
Metrics
References
Fabbrocini G, Cantelli M, Masarà A, Annunziata MC, Marasca C, Cacciapuoti S. Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review. Int J Womens Dermatol. 2018;4(4):203-11.
Ramos PM, Miot HA. Female Pattern Hair Loss: a clinical and pathophysiological review. An Bras Dermatol. 2015;90(4):529-43.
Bhat YJ, Saqib NU, Latif I, Hassan I. Female Pattern Hair Loss-An Update. Indian Dermatol Online J. 2020;11(4):493-501.
Rossi A, D'Arino A, Pigliacelli F, Caro G, Muscianese M, Fortuna MC et al. The diagnosis of androgenetic alopecia in children: Considerations of pathophysiological plausibility. Australas J Dermatol. 2019;60(4):e279-e83.
Herskovitz I, Tosti A. Female pattern hair loss. Int J Endocrinol Metab. 2013;11(4):e9860.
Gupta M, Mysore V. Classifications of Patterned Hair Loss: A Review. J Cutan Aesthet Surg. 2016;9(1):3-12.
Ludwig E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br J Dermatol. 1977;97(3):247-54.
Sinclair R, Wewerinke M, Jolley D. Treatment of female pattern hair loss with oral antiandrogens. Br J Dermatol. 2005;152:466-73.
Vujovic A, Del Marmol V. The female pattern hair loss: review of etiopathogenesis and diagnosis. Biomed Res Int. 2014;2014:767628.
Dinh QQ, Sinclair R. Female pattern hair loss: current treatment concepts. Clin Interv Aging. 2007;2(2):189-99.
Singal A, Sonthalia S, Verma P. Female pattern hair loss. Indian J Dermatol Venereol Leprol. 2013;79:626-40.
Suchonwanit P, Thammarucha S, Leerunyakul K. Minoxidil and its use in hair disorders: a review. Drug Des Devel Ther. 2019;13:2777-86.
Minoxidil. Available at: https://www.ncbi.nlm.nih.gov/books/NBK482378/. Accessed on 4 August 2021.
Recommendations of the SEC (Dermatology & Allergy) made in its 60th meeting held on 12.08.2021 at CDSCO HQ New Delhi. Available at https://cdsco.gov.in/opencms/resources/UploadCDSCOWeb/2018/UploadCommitteeFiles/Recommendations%20of%20the%20SECDermatologyAllergy.pdf. Accessed on 21 September 2021.
Kanti V, Messenger A, Dobos G, Reygagne P, Finner A, Blumeyer A, et al. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men - short version. J Eur Acad Dermatol Venereol. 2018;32(1):11-22.
Ioannides D, Lazaridou E. Female pattern hair loss. Curr Probl Dermatol. 2015;47:45-54.
Blume-Peytavi U, Hillmann K, Dietz E, Canfield D, Garcia Bartels N. A randomized, single-blind trial of 5% minoxidil foam once daily versus 2% minoxidil solution twice daily in the treatment of androgenetic alopecia in women. J Am Acad Dermatol. 2011;65(6):1126-34.
Lucky AW, Piacquadio DJ, Ditre CM, Dunlap F, Kantor I, Pandya AG et al. A randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss. J Am Acad Dermatol. 2004;50(4):541-53.
Levy LL, Emer JJ. Female pattern alopecia: current perspectives. Int J Womens Health. 2013;5:541-56.
Purnak T, Senel E, Sahin C. Liquid formulation of minoxidil versus its foam formulation. Indian J Dermatol. 2011;56(4):462.
Carmina E, Azziz R, Bergfeld W, Escobar-Morreale HF, Futterweit W, Huddleston H et al. Female Pattern Hair Loss and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee. J Clin Endocrinol Metab. 2019;104(7):2875-91.
DeVillez RL, Jacobs JP, Szpunar CA, Warner ML. Androgenetic alopecia in the female. Treatment with 2% topical minoxidil solution. Arch Dermatol. 1994;130(3):303-7.
Piraccini B, Starace M, Alessandrini A, Guarrera M, Fiorucci MC, Lorenzi S. Efficacy and tolerability of 5% minoxidil solution (Carexidil®) in male and female androgenetic alopecia: a 6-month open multicentric study. G Ital Dermatol Venereol. 2011;146(6-1):1-8.
Rossi A, Cantisani C, Melis L, Iorio A, Scali E, Calvieri S. Minoxidil use in dermatology, side effects and recent patents. Recent Pat Inflamm Allergy Drug Discov. 2012;6(2):130-6.
Mysore V, Parthasaradhi A, Kharkar RD, Ghoshal AK, Ganjoo A, Ravichandran G et al. Expert consensus on the management of androgenetic alopecia in India. Int J Trichol. 2019;11:101-6.
Khattab FM, Bessar H. Accelerated hair growth by combining thread monofilament and minoxidil in female androgenetic alopecia. J Cosmet Dermatol. 2020;19(7):1738-44.
Esmat SM, Hegazy RA, Gawdat HI, Abdel Hay RM, Allam RS, El Naggar R et al. Low-level light-minoxidil 5% combination versus either therapeutic modality alone in management of female patterned hair loss: A randomized controlled study. Lasers Surg Med. 2017;49(9):835-43.
Liu Y, Jiang LL, Liu F, Qu Q, Fan ZX, Guo Z et al. Comparison of low-level light therapy and combination therapy of 5% minoxidil in the treatment of female pattern hair loss. Lasers Med Sci. 2021;36(5):1085-93.
Sarkar R, Vartak S, Acharya S, Kursam NK, Mane A, Mehta S et al. Comparative Study to Evaluate Tolerability of Topical 5% Minoxidil Novel Formulation and Alcohol-Based Conventional Solutions in Treatment of Androgenetic Alopecia in Indian Men: Randomized Double-Blind Study. Dermatol Ther (Heidelb). 2020;10(3):469-79.
Kovacevic M, McCoy J, Shapiro J, Sinclair R, Vaño-Galvan S, Goldust M et al. Novel "After Minoxidil" spray improves topical minoxidil compliance and hair style manageability. J Cosmet Dermatol. 2020;19(10):2647-9.
Randolph M, Tosti A. Oral minoxidil treatment for hair loss: A review of efficacy and safety. J Am Acad Dermatol. 2021;84(3):737-46.
Sinclair RD. Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. Int J Dermatol. 2018;57(1):104-9.
Conic RR, Khetarpal S, Bergfeld W. Treatment of female pattern hair loss with combination therapy. Semin Cutan Med Surg. 2018;37(4):247-53.
Brough KR, Torgerson RR. Hormonal therapy in female pattern hair loss. Int J Womens Dermatol. 2017;3(1):53-7.
Hoedemaker C, van Egmond S, Sinclair R. Treatment of female pattern hair loss with a combination of spironolactone and minoxidil. Australas J Dermatol. 2007;48(1):43-5.
Tanaka Y, Aso T, Ono J. Combination Therapy to Treat Asian Female Pattern Hair Loss. J Cosmetics, Dermatol Sci Applications. 2019;9(3):216-22.
Suchonwanit P, Iamsumang W, Rojhirunsakool S. Efficacy of Topical Combination of 0.25% Finasteride and 3% Minoxidil Versus 3% Minoxidil Solution in Female Pattern Hair Loss: A Randomized, Double-Blind, Controlled Study. Am J Clin Dermatol. 2019;20(1):147-53.
Avram MR, Cole JP, Gandelman M, Haber R, Knudsen R, Leavitt MT et al. The potential role of minoxidil in the hair transplantation setting. Dermatol Surg. 2002;28(10):894-900.
Pakhomova EE, Smirnova IO. Comparative Evaluation of the Clinical Efficacy of PRP-Therapy, Minoxidil, and Their Combination with Immunohistochemical Study of the Dynamics of Cell Proliferation in the Treatment of Men with Androgenetic Alopecia. Int J Mol Sci. 2020;21(18):6516.
Dhurat R, Sukesh M, Avhad G, Dandale A, Pal A, Pund P. A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study. Int J Trichol. 2013;5(1):6-11.