Summation and Recommendations for the Safe and Effective Use of Topical and Oral Minoxidil

April 2025 in “ Journal of the American Academy of Dermatology ”

Elise A. Olsen, Rodney Sinclair, Maria Hordinsky, Natasha Atanaskova Mesinkovska, Neil S. Sadick, Jerry Shapiro, Wilma F. Bergfeld

minoxidil topical minoxidil oral minoxidil hair loss treatment protocols side effects patient education Rogaine

TLDR Use minoxidil correctly and be aware of side effects for best hair loss treatment results.

The document reviews the use of topical and low-dose oral minoxidil for treating hair loss, highlighting its efficacy in various alopecia conditions. Topical minoxidil is effective but requires daily application, while low-dose oral minoxidil is used off-label with no standard guidelines. Experts in hair disorders reviewed literature and shared experiences to provide recommendations for safe and effective use. The review emphasizes understanding key aspects of minoxidil use to ensure safety and efficacy in treating hair loss.

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The Role of Patient and Drug-Related Factors in Oral Minoxidil and Pericardial Effusion: Analyses of Data From the United States Food and Drug Administration Adverse Event Reporting System

research The Role of Patient and Drug-Related Factors in Oral Minoxidil and Pericardial Effusion: Analyses of Data From the United States Food and Drug Administration Adverse Event Reporting System

December 2024 in “Journal of Cosmetic Dermatology”

Oral minoxidil rarely causes pericardial effusion, especially at low doses.

research Evaluation of the Safety and Effectiveness of Oral Minoxidil in Children: A Systematic Review

June 2024 in “Dermatology and therapy”

Low-dose oral minoxidil is safe for treating children's hair disorders.

research Intradermal Delivery of Alopecia Therapeutics: Current State and Future Prospects

June 2023 in “Dermatologic Surgery”

New injection methods for hair loss treatment show promise but need more research.

research Systemic Minoxidil for Hair Disorders in Pediatric Patients: A Safety and Tolerability Review

August 2022 in “International Journal of Dermatology”

Low-dose oral and sublingual minoxidil seem safe for children with hair disorders.

research Before-After Study With 24-Hour Ambulatory Blood Pressure Monitoring After the First Dose of 5 Mg Oral Minoxidil

August 2022 in “Journal of The American Academy of Dermatology”

A 5-mg dose of oral minoxidil slightly lowers blood pressure temporarily, especially in those with higher initial blood pressure.

research Pericardial, Pleural Effusion and Anasarca: A Rare Complication of Low-Dose Oral Minoxidil for Hair Loss

3 citations , August 2022 in “JAAD case reports”

A woman developed swelling in her body after taking low-dose oral minoxidil for hair loss, but it resolved after stopping the medication.

research Efficacy and Safety of 5% Minoxidil Alone, Minoxidil Plus Oral Spironolactone, and Minoxidil Plus Microneedling on Female Pattern Hair Loss: A Prospective, Single-Center, Parallel-Group, Evaluator-Blinded, Randomized Trial

2 citations , July 2022 in “Frontiers in Medicine”

Combining minoxidil with microneedling or spironolactone is more effective for female hair loss than using minoxidil alone.

Prospective Cardiovascular Evaluation with 24-Hour Holter and Ambulatory Blood Pressure Monitoring in Men Using 5-mg Oral Minoxidil for Androgenetic Alopecia

research Prospective Cardiovascular Evaluation with 24-Hour Holter and Ambulatory Blood Pressure Monitoring in Men Using 5-mg Oral Minoxidil for Androgenetic Alopecia

3 citations , May 2022 in “Journal of The American Academy of Dermatology”

The conclusion is that 24 weeks of low-dose oral minoxidil is safe for men with hair loss, with no significant changes in heart rate or blood pressure.

research Low-Dose Oral Minoxidil for Treatment of Androgenetic Alopecia and Telogen Effluvium in a Pediatric Population: A Descriptive Study

6 citations , April 2022 in “Journal of The American Academy of Dermatology”

Low-dose oral minoxidil improved hair growth in most pediatric patients with mild side effects.

Sublingual Minoxidil for the Treatment of Male and Female Pattern Hair Loss: A Randomized, Double-Blind, Placebo-Controlled, Phase 1B Clinical Trial

research Sublingual Minoxidil for the Treatment of Male and Female Pattern Hair Loss: A Randomized, Double-Blind, Placebo-Controlled, Phase 1B Clinical Trial

5 citations , August 2021 in “Journal of The European Academy of Dermatology and Venereology”

Sublingual minoxidil safely promotes hair growth.

research SULT1A1 (Minoxidil Sulfotransferase) Enzyme Booster Significantly Improves Response to Topical Minoxidil for Hair Regrowth

1 citations , June 2021 in “Journal of Cosmetic Dermatology”

Enzyme booster SULT1A1 greatly enhances hair regrowth with minoxidil.

Low-Level Light Therapy Downregulates Scalp Inflammatory Biomarkers in Men With Androgenetic Alopecia and Boosts Minoxidil 2% for Sustainable Hair Regrowth

research Low-Level Light Therapy Downregulates Scalp Inflammatory Biomarkers in Men With Androgenetic Alopecia and Boosts Minoxidil 2% for Sustainable Hair Regrowth

4 citations , May 2021 in “Lasers in Surgery and Medicine”

Light therapy reduces scalp inflammation, boosts hair regrowth with Minoxidil 2%.

research Review of Oral Minoxidil as Treatment of Hair Disorders: In Search of the Perfect Dose

21 citations , March 2021

Oral minoxidil effectively treats hair loss, with women needing lower doses (0.25 to 2.5 mg daily) and men needing higher doses (1.25 to 5 mg daily).

research Safety of Low-Dose Oral Minoxidil for Hair Loss: A Multicenter Study of 1404 Patients

39 citations , February 2021 in “Journal of The American Academy of Dermatology”

Low-dose oral minoxidil safely treats hair loss, with hypertrichosis as main side effect.

Comparison of 5% Minoxidil Lotion Monotherapy Versus Its Combination with Autologous Platelet-Rich Plasma in Androgenetic Alopecia in One Hundred Males

research Comparison of 5% Minoxidil Lotion Monotherapy Versus Its Combination with Autologous Platelet-Rich Plasma in Androgenetic Alopecia in One Hundred Males

3 citations , February 2021 in “Medical journal, Armed Forces India”

Combination therapy promotes better hair growth and density.

research Combination Oral Minoxidil and Spironolactone for the Treatment of Androgenetic Alopecia in Adolescent Girls

5 citations , December 2020 in “Journal of The American Academy of Dermatology”

Minoxidil and spironolactone improve hair density and reduce shedding in girls.

research Adverse Effects of Low-Dose Oral Minoxidil for Androgenetic Alopecia in 435 Patients

7 citations , November 2020 in “Journal of The American Academy of Dermatology”

Low-dose oral minoxidil may cause side effects like hypertrichosis and is not suitable for everyone.

research Low-Dose Oral Minoxidil for Treating Alopecia: A 3-Year North American Retrospective Case Series

9 citations , October 2020 in “Journal of The American Academy of Dermatology”

Low-dose oral minoxidil is an effective and well-tolerated treatment for hair growth in alopecia patients.

research Characterization and Management of Hypertrichosis Induced by Low-Dose Oral Minoxidil in the Treatment of Hair Loss

7 citations , September 2020 in “Journal of The American Academy of Dermatology”

Low-dose oral minoxidil for hair loss can cause mild excessive hair growth, usually appearing within the first 3 months, but it can be managed by adjusting the dose or removing the unwanted hair, with most people not needing to stop the treatment.

research Low-Dose Oral Minoxidil as Treatment for Non-Scarring Alopecia: A Systematic Review

19 citations , June 2020 in “International Journal of Dermatology”

Low-dose oral minoxidil effectively treats non-scarring hair loss with some side effects like hypertrichosis and postural hypotension.

research Minoxidil Induced Central Serous Chorioretinopathy Treated with Oral Eplerenone – A Case Report

4 citations , June 2020 in “BMC Ophthalmology”

Minoxidil can cause a rare eye condition, but it was successfully treated with oral Eplerenone in one case.

research How Safe Is Prescribing Oral Minoxidil in Patients Allergic to Topical Minoxidil?

8 citations , April 2020 in “Journal of The American Academy of Dermatology”

Oral minoxidil is a reasonably safe alternative for patients allergic to the topical form.

research Minoxidil 1 mg Oral Versus Minoxidil 5% Topical Solution for the Treatment of Female-Pattern Hair Loss: A Randomized Clinical Trial

53 citations , August 2019 in “Journal of The American Academy of Dermatology”

Oral minoxidil and topical minoxidil 5% both effectively improve female-pattern hair loss with safe side effects.

research Pediatric Androgenetic Alopecia: A Review

8 citations , August 2019 in “Journal of The American Academy of Dermatology”

Early diagnosis and treatment, like topical minoxidil, can prevent hair loss in children.

research Off-Label Use of Topical Minoxidil in Alopecia: A Review

32 citations , January 2019 in “American Journal of Clinical Dermatology”

Minoxidil helps treat eyebrow thinning, monilethrix, early hair loss, and shortens chemo-related hair loss.

Characterization of Follicular Minoxidil Sulfotransferase Activity in a Cohort of Pattern Hair Loss Patients from the Indian Subcontinent

research Characterization of Follicular Minoxidil Sulfotransferase Activity in a Cohort of Pattern Hair Loss Patients from the Indian Subcontinent

8 citations , October 2018 in “Dermatologic Therapy”

About 41% of Indian hair loss patients have low enzyme activity that affects hair loss treatment effectiveness, with men affected more than women. Testing for this can guide treatment.

research Low-Dose Daily Aspirin Reduces Topical Minoxidil Efficacy in Androgenetic Alopecia Patients

12 citations , September 2018 in “Dermatologic Therapy”

Daily low-dose aspirin lowers minoxidil's effectiveness for hair loss treatment.

research The Hair Shedding Visual Scale: A Quick Tool to Assess Hair Loss in Women

16 citations , February 2017 in “Dermatology and Therapy”

The new visual scale is a quick and effective way to measure hair loss in women.

research Minoxidil Topical Treatment May Be More Efficient If Applied on Damp Scalp Compared to Dry Scalp

13 citations , June 2016 in “Dermatologic Therapy”

Minoxidil works better when applied on a damp scalp than a dry one.

research Hair Shedding in Women: How Much Is Too Much?

32 citations , April 2015 in “British Journal of Dermatology”

The hair shedding scale accurately identifies abnormal hair shedding in women with long hair, with grades 5 and 6 indicating excessive shedding.

Similar Response Patterns to Topical Minoxidil Foam 5% in Frontal and Vertex Scalp of Men with Androgenetic Alopecia: A Microarray Analysis

research Similar Response Patterns to Topical Minoxidil Foam 5% in Frontal and Vertex Scalp of Men with Androgenetic Alopecia: A Microarray Analysis

19 citations , September 2014 in “British Journal of Dermatology”

Minoxidil foam 5% effectively treats hair loss in both frontal and vertex scalp regions.

research Topical Minoxidil Treatment for Congenital Alopecia in Hypohidrotic Ectodermal Dysplasia

12 citations , March 2013

Minoxidil cream can safely treat hair loss in kids with ectodermal dysplasia.

research Central Chorioretinopathy Associated with Topical Use of Minoxidil 2% for Treatment of Baldness

9 citations , September 2011 in “Cutaneous and Ocular Toxicology”

Using 2% minoxidil for baldness treatment might cause vision distortion due to fluid build-up under the retina.

A Multicenter, Randomized, Placebo-Controlled, Double-Blind Clinical Trial of a Novel Formulation of 5% Minoxidil Topical Foam Versus Placebo in the Treatment of Androgenetic Alopecia in Men

research A Multicenter, Randomized, Placebo-Controlled, Double-Blind Clinical Trial of a Novel Formulation of 5% Minoxidil Topical Foam Versus Placebo in the Treatment of Androgenetic Alopecia in Men

142 citations , August 2007 in “Journal of The American Academy of Dermatology”

New 5% minoxidil foam effectively promotes hair growth and is safe for use.

research Topical Use of Minoxidil in Children and Systemic Side Effects

58 citations , January 2007 in “Dermatology”

Minoxidil use in children may cause heart issues.

research Short Anagen Syndrome

37 citations , July 2005 in “Journal of The American Academy of Dermatology”

Short anagen syndrome involves a hair growth phase lasting 1.5 years.

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219 citations , March 2004 in “Journal of The American Academy of Dermatology”

5% and 2% minoxidil solutions effectively promote hair growth and reduce hair loss, with 5% being slightly more effective but having more side effects.

research Minoxidil: Mechanisms of Action on Hair Growth

397 citations , February 2004 in “British Journal of Dermatology”

Minoxidil boosts hair growth by opening potassium channels and increasing cell activity.

research Pseudoacromegaly Induced by the Long-Term Use of Minoxidil

41 citations , June 2003 in “Journal of The American Academy of Dermatology”

Long-term minoxidil use can cause pseudoacromegaly, but stopping it improves symptoms.

research Hypertrichosis in Females Applying Minoxidil Topical Solution and in Normal Controls

63 citations , April 2003 in “Journal of The European Academy of Dermatology and Venereology”

Minoxidil use increases facial hair growth in females, more in older users.

A Randomized Clinical Trial of 5% Topical Minoxidil Versus 2% Topical Minoxidil and Placebo in the Treatment of Androgenetic Alopecia in Men

research A Randomized Clinical Trial of 5% Topical Minoxidil Versus 2% Topical Minoxidil and Placebo in the Treatment of Androgenetic Alopecia in Men

269 citations , August 2002 in “Journal of The American Academy of Dermatology”

5% minoxidil works better for hair growth and density, with minor irritation.

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84 citations , April 2002 in “Archives of Dermatology”

Loose anagen hair syndrome may be caused by keratin gene mutations.

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127 citations , July 1996 in “Journal of The American Academy of Dermatology”

Minoxidil shortens baldness from chemotherapy by 50.2 days without significant side effects.

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82 citations , March 1994 in “Archives of Dermatology”

2% topical minoxidil effectively treats female hair loss with minimal side effects.

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58 citations , October 1993 in “International Journal of Dermatology”

Minoxidil helps hair growth and reduces shedding in women.

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42 citations , July 1993 in “Journal of Investigative Dermatology”

research Minoxidil Sulfate Is the Active Metabolite That Stimulates Hair Follicles

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Minoxidil sulfate stimulates hair growth.

research Relationship Between Contact Time of Applied Dose and Percutaneous Absorption of Minoxidil From a Topical Solution

25 citations , June 1990 in “Journal of Pharmaceutical Sciences”

Longer contact time increases minoxidil absorption, but doesn't affect metabolism.

research Influence of Tretinoin on the Percutaneous Absorption of Minoxidil from an Aqueous Topical Solution

30 citations , April 1990 in “Clinical Pharmacology & Therapeutics”

Tretinoin cream boosts minoxidil absorption, possibly improving hair loss treatment.

research Five-Year Follow-Up of Men with Androgenetic Alopecia Treated with Topical Minoxidil

70 citations , April 1990 in “Journal of The American Academy of Dermatology”

Minoxidil treatment increased hair growth for up to 5 years, requiring twice daily application.

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Stopping minoxidil treatment resumes balding; continuous use needed for results.

research Minoxidil

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Double-Blind, Placebo-Controlled Evaluation of Topical Minoxidil in Extensive Alopecia Areata

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138 citations , August 1985 in “Journal of The American Academy of Dermatology”

Minoxidil promotes hair growth in male pattern baldness.

research Percutaneous Absorption of Minoxidil in Humans

52 citations , February 1985 in “Archives of Dermatology”

Minoxidil absorbs poorly through skin, with low risk of side effects at 1-2% concentration.

research Minoxidil

45 citations , January 1981 in “Annals of Internal Medicine”

Minoxidil controls blood pressure effectively, but may cause side effects like hypertrichosis.

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research Minoxidil Sulfotransferase Enzymatical Activity in Plants: A Novel Paradigm in Increasing Minoxidil Response in Androgenetic Alopecia

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