Systematic Review of Minoxidil

Minoxidil is the only unisex hair loss treatment to be both MHRA-licensed and FDA-approved for the common hereditary condition, androgenetic alopecia (Male Pattern Baldness and Female Pattern Hair Loss).

However, it has also been seen to produce significant results when used off-label to treat patchy hair loss of the scalp caused by the autoimmune disorder Alopecia Areata.

Researchers from the Universidade Federal de São Paulo in Brazil have now conducted a systematic review into the use of topical high strength minoxidil to treat the scalp-only form of Alopecia Areata – the approach Belgravia takes – with promising results.

Effective with no adverse events reported

As part of a range of 80 therapeutic Alopecia Areata interventions being reviewed for safety and efficacy, topical applications of minoxidil were considered to be among the “most promising” for men, women and children, according to the Brazilian report.

This was published in the Journal of the European Academy of Dermatology and Venereology on 5th March 2019 and posted online in June 2019, though it was originally submitted in October 2018.

As to the methodology involved, corresponding author P.C.B. Freire writes: “An extensive search was conducted of international medical literature involving randomized clinical trials (RCTs) of AA interventions. RCTs were evaluated qualitatively and quantitatively according to the previously published protocol and for seven specific outcomes.” Continues below…

Minoxidil is a vasodilator which is believed to promote accelerated hair growth locally by opening the potassium channels, improving bloodflow to the area. It is a dose-dependent drug which is available over-the-counter in strengths of up to 5 per cent, though higher strength versions of the hair loss solution are also available.

The Brazilian study involved a meta-analysis of 5% strength minoxidil which, when compared to a placebo, was found to have “presented a significant difference in favor of 5% minoxidil with the moderate quality of evidence in children and adults with patchy AA (RR 8.37 [3.16–22.14], 95% CI)”. Furthermore, no severe adverse events were reported.

Following their review, researchers concluded, “Treatment of patchy AA with 5% minoxidil proved effective, and clinically and statistically safe in studies with limited sample size; quality of evidence was moderate”. They also noted that “Further studies with sound methodological quality, more participants and outcome observations lasting longer than 6 months are needed to address remaining uncertainties.”

Sudden hair loss which can recur

Alopecia Areata is both the name for the group of autoimmune disorders which cause sudden-onset hair loss, and the mildest form which solely affects the scalp. Other phenotypes include Alopecia Totalis and Alopecia Universalis, which present as total baldness of the head, including facial hair, and complete hairlessness from head to toe, respectively.

Alopecia Areata is understood to affect 0.2 per cent of the global population, making it the most common hair loss condition worldwide, behind androgenetic alopecia. It can affect men, women and children of all races and occurs when the body mistakenly attacks hair follicles, disrupting the normal functioning of the hair growth cycle.

Although its precise cause is unknown, triggers are believed to include sudden shock or trauma, allergies, infections, hormones and genetic factors.

Where the scalp-only form is concerned, although Alopecia Areata treatment courses are available, normal hair growth will generally resume naturally within 12 months. Initially this regrowth may appear pale in colour, but this should also be a temporary problem.

Once the hair has regrown, it is still possible for the condition to recur in the future as it is known to wax and wane, with spontaneous hair growth and hair loss coming and going in some people. It has recently been shown that these recurrences may decrease over time, however.

For those with the more extensive versions, hospital-based therapies, including steroid treatment and immunotherapy, may be beneficial, though the success rate is relatively low. This is why the FDA has thrown its weight behind encouraging pharmaceutical companies to develop a safe and effective treatment for all forms of Alopecia Areata, granting Breakthrough designation or Fast Track status to a number who are showing solid progress in the area of JAK inhibiton.

It is hoped that the first JAK inhibitor treatments for Alopecia Areata, Totalis and Universalis may be made available by 2022 though there is still more work to do in order to meet necessary regulatory approval requirements ahead of this estimated release date.

In the meantime, adults with scalp-only Alopecia Areata may get treatment recommendations from a dedicated hair loss clinic, whilst children with any type and adults with the more severe forms should consult their GP or dermatologist for the appropriate referrals.