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Background:
Minoxidil and spironolactone are oral antihypertensives known to stimulate hair growth.
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 d...
Citations
... Fortunately, with doses like 0.25-5 mg daily, the impact on systemic pressure was minor (11). Postural hypotension can be treated with 50 mg of sodium chloride daily (23). Similar to topical solutions, oral minoxidil is also associated with temporary hair loss at the beginning of the therapy, which can last approximately 3-6 weeks. ...
Introduction and purposeAndrogenetic alopecia (AGA) is one of the most common causes of baldness worldwide. It affects up to 80% of men by the age of 70 and up to 40% of postmenopausal women. In AGA etiology and pathogenesis, the three essential components play a key role - genetic inheritance, patient age and hormonal effects of androgens. In the following review, we have described the available FDA-approved and off-label treatments for AGA, along with their efficacy and potential side effects that should always be considered to prevent treatment discontinuation by the patients.The state of knowledgeThe pathogenesis of AGA is based on inherited dihydrotestosterone (DHT) sensitivity in the scalp skin, which leads to progressive hair loss. The literature documents the effectiveness of several treatments with different mechanisms of action in AGA therapy, but only topical minoxidil and oral finasteride gained FDA approval so far. Minoxidil acts by the blood vessels dilatation that increases the flow of oxygenated and growth factor-enriched blood to the hair follicles in the skin. 5-alpha reductase inhibitors, such as finasteride and dutasteride are another threapeutic option. Thy act by the inhibition of 5-alpha reductase, the enzyme which converts testosterone to DHT - the main causative agent of androgenetic alopecia. Recently, topical applications of minoxidil and finasterid, along with completely new emerging treatments for androgenetic alopecia are gaining popularity among doctors and patients. SummaryThis review describes current treatments for AGA, considering their efficacy, optimal doses, and the most common side effects. An important fact to emphasise is that androgenetic alopecia is based on a genetic predisposition, and treatment requires long-term use. For this reason, when choosing a medication, it is essential to cooperate with the patient and combine different therapeutic methods to achieve the desirable outcome while avoiding adverse reactions.
... Thuốc dạng viên 2,5 mg và có thể được cắt thành liều nhỏ hơn để đạt được liều lượng an toàn tối ưu trong điều trị AGA. Sinclair lần đầu tiên báo cáo sự kết hợp giữa minoxidil 0,25 mg đường uống và spironolactone 25mg là một lựa chọn an toàn và hiệu quả trong việc kiểm soát chứng rụng tóc ở phụ nữ [16]. ...
Rụng tóc nội tiết tố nam (Androgenetic alopecia - AGA) là dạng rụng tóc phổ biến nhất, có thể ảnh hưởng đến chất lượng cuộc sống của cá nhân. Mặc dù có sẵn nhiều lựa chọn điều trị nội khoa, phẫu thuật, liệu pháp ánh sáng và dinh dưỡng để làm chậm hoặc đảo ngược sự tiến triển của AGA, nhưng việc lựa chọn liệu pháp thích hợp vẫn là một thách thức. Bài báo tổng quan các lựa chọn điều trị chứng AGA có tính đến hiệu quả, tác dụng không mong muốn, tính thực tiễn của việc tuân thủ điều trị và chi phí để giúp các bác sĩ đưa ra chế độ điều trị phù hợp (cả về mặt đạo đức) cho bệnh nhân.
... Although other pathways are known to be part of the pathophysiology of AGA, the androgens activity in the follicle is the main target of therapeutic strategies [1]. Drugs used for treatments of AGA such as spironolactone [7][8][9][10][11], finasteride [12-17] -and most recently du-tasteride1 and bicalutamide [18,10, 21] -are examples of this specific targeting. As for other pathways, which run parallel to androgens, they receive less attention in the therapeutic approach. ...
... Although other pathways are known to be part of the pathophysiology of AGA, the androgens activity in the follicle is the main target of therapeutic strategies [1]. Drugs used for treatments of AGA such as spironolactone [7][8][9][10][11], finasteride [12-17] -and most recently du-tasteride1 and bicalutamide [18,10, 21] -are examples of this specific targeting. As for other pathways, which run parallel to androgens, they receive less attention in the therapeutic approach. ...
Introduction: Androgens have always been known to play a major role in the pathophysiology of androgenetic alopecia. They are responsible for the AGA development and progression along with other triggers such as the Wnt/B-catenin pathway, PGD2, perifollicular inflammation, tension in the galea aponeurotica, epigenetic factors, psychogenic factors and oxidative stress. The great importance given to androgens role in AGA is reinforced by studies of antiandrogen drugs for the treatment of the disease, which are very effective to patients who take them properly. However, studies show that in the last decades the serum androgens levels are decreasing in the general population. Perspective: Researches have also shown that the severity of androgenetic alopecia has gotten worse over the years, reaching more important levels at times in life when androgens are no longer present in concentrations as significant as they were before the age of 30. The purpose of this study is to discuss the true role of androgens in the pathophysiology of AGA, as well as to suggest a more careful approach to the already known causes and pathways that participate in the disease including the therapeutic management of patient´s problems.
... Sinclair [13] reported the results of an observational study involving 100 women (mean age 48.44 years) with female pattern hair loss (Sinclair stage 2-5) treated with combination of oral minoxidil 0.25 mg and spironolactone 25 mg per day for 12 months. Mean reduction in hair loss severity score at 6 and 12 months was 0.85 and 1.3, respectively. ...
... In an observational study by Sinclair [13] involving 100 women with female pattern hair loss (Sinclair stage 2-5) treated with combination of oral minoxidil 0.25 mg and spironolactone 25 mg per day for 12 months, mean change in systolic and diastolic blood pressure was − 4.52 mmHg and − 6.48 mmHg, respectively. There was no abnormality in blood tests. ...
Alopecia is a highly prevalent condition worldwide including in India. There are different types of alopecia with differing etiology, presentation, and hence treatment. Androgenetic alopecia represents the most common form of hair loss affecting male as well as female population termed as male and female pattern hair loss, respectively. Several treatment options are available for the treatment of alopecia with often unsatisfactory results resulting in psychological distress among such patients. Topical minoxidil is known to be effective in the treatment of alopecia. However, oral minoxidil is not currently approved for the treatment of alopecia. This expert consensus is prepared to provide guidance to the clinicians regarding the use of oral minoxidil in the treatment of alopecia. Extensive literature review was performed to prepare the draft consensus which was then revised based on the suggestions and comments from the experts. The final draft was circulated to the experts for review and approval. This consensus document provides overview of evidence related to oral minoxidil and consensus from the experts for its use in the treatment of minoxidil.
... In a trial to minimize the fluid/sodium retention induced by MNX, OM was given in a daily dose of 0.25 mg in combination with spironolactone in a dose of 25 mg. An increase in efficacy with a good safety profile of OM was shown [40]. ...
This review is aimed at elucidating the efficacy and safety of oral minoxidil (OM) for the treatment of hair loss (HL), especially androgenic alopecia (AGA), and at highlighting its future applications. A comprehensive review of the published literature concerning the management of various types of non-scarring HL was performed. The review focused on the therapeutic role of minoxidil (MNX) in HL for both sexes and various age groups.
Recent studies suggested the effectiveness of OM in the dose range of 0.625–2.5 mg daily and in male pattern hair loss (MPHL), with gradual increase up to 5 mg/day. Low-dose OM (LDOM) showed effectiveness in various types of HL in both sexes and in pediatric patients. OM was more advantageous than topical MNX because it was more convenient, cost-effective, and compliant with the application of adjuvant co‐therapy. Five α-reductase inhibitors offer an effective treatment for HL but are associated with male sexual dysfunction. Oral MNX surpassed 5α-reductase inhibitors regarding effectiveness in addition to its vasodilator effect, which improves male sexual function.
OM could be considered a convenient and safe therapy for various types of HL, specifically AGA. LDOM could be appropriate for pediatric age groups and patients intolerant to hypertrichosis. Since OM can improve erectile function, it is more convenient for male patients.
... Atualmente, existem duas drogas para o tratamento da AAG aprovadas pelo FDA (Food and Drug Administration), a finasterida oral e o minoxidil tópico, embora muitos outros tratamentos ainda não aprovados pelo FDA venham mostrando resultados promissores [3,10,11,12,13,14]. ...
A alopécia androgenética (AAG) é uma patologia dermatológica de caráter multifatorial, de origem poligênica, caracterizada pela alteração do ciclo capilar, levando a uma miniaturização folicular progressiva, que deixa os fios terminais mais finos e menos pigmentados. Objetivos: avaliar a eficácia e os efeitos colaterais do tratamento com plasma rico em plaquetas em pacientes portadores de AAG. Materiais e métodos: Trata-se de uma revisão integrativa, em que a questão norteadora foi “O plasma rico em plaquetas é eficaz no tratamento da alopécia androgenética?”. A busca pelos artigos ocorreu na base de dados PubMed a partir dos termos “efficacy”, “platelet-rich plasma”, “treatment” e “androgenetic alopecia”, combinados entre si pelo operador booleano AND. Resultados e discussão: Os resultados da pesquisa demonstraram que o PRP tem eficácia no tratamento da AAG, sem grandes efeitos colaterais. Dos 13 artigos analisados, 4 compararam a eficácia da terapia com o PRP em relação ao Minoxidil, sendo que um deles fez a análise das duas substâncias em terapia combinada. Os estudos comparativos entre o PRP e Minoxidil mostraram que ambos foram bem tolerados e eficazes. Uma meta-análise que buscou identificar a eficácia da monoterapia com PRP em homens e mulheres separadamente, avaliando a densidade e o diâmetro capilar, o PRP aumentou significativamente o diâmetro capilar em ambos os sexos, mas a densidade capilar foi significativamente aumentada somente nos sexo masculino. Conclusão: A maioria dos trabalhos analisados nesta revisão mostraram resultados positivos em ralação ao uso do PRP na AAG, tanto no sexo masculino como no feminino.
... Women typically receive lower doses, ranging from 0.25 mg to 1.25 mg per day with the initial dose of 0.25 mg per day [19][20][21][22]. In women, the effects of the use of 0.25 mg of minoxidil can often be enhanced by adding 25 mg of spironolactone per day [23]. The clinical and trichological reassessment should take place 6 months after the initiation of therapy in order to mainly determine if it is needed to increase the dosage. ...
... The standard treatment protocol for FPHL usually requires starting with 50 mg of spironolactone per day for the first one or two weeks, then the dose is increased to 100 mg per day which accounts for a standard dose that can be finally increased up to 200 mg per day [58,59]. Spironolactone is often used in conjunction with oral or 5% topical minoxidil, especially when the treatment is performed with small doses of spironolactone (25-50 mg) [23,58]. In women, low doses of oral minoxidil (0.25-1.25 mg) are usually a part of the combination therapy. ...
... Common side effects observed included hypertrichosis and pedal edema, with no instances of scalp pruritus. Apart from minoxidil as a standalone treatment, an observational pilot study conducted on 100 patients with FPHL revealed that once daily intake of capsules con-taining a combination of 0.25 mg of minoxidil and 25 mg of spironolactone proved to be both safe and effective for 12 months [36]. ...
Low-dose oral minoxidil (LDOM) has demonstrated a promising safety and efficacy profile in the treatment of various hair disorders, including male androgenetic alopecia (AGA) and female-pattern hair loss (FPHL); however, it lacks FDA approval. The usual LDOM starting dose for male AGA is 1–5 mg/day, depending on physician preference and the patient’s condition. For FPHL, it is 0.5–1 mg/day. The maximum dose is generally 5 mg/day. If patients respond well without major side effects, the dose may be gradually increased since the LDOM’s efficacy appears to be dose-dependent. Patients may use LDOM long term if the treatment outcome is satisfactory. The common side effects of LDOM are hypertrichosis and cardiovascular symptoms. Females are more prone to hypertrichosis than males. The side effects of LDOM can be categorized as (a) dose-dependent type A side effects (hypertrichosis and cardiovascular symptoms) and (b) idiosyncratic type B side effects (pericardial effusion). Minoxidil acts via multiple pathways. Although minoxidil has a relatively short half-life of around 4 h, its hypotensive effect may last approximately 72 h. Effective treatments for alopecia are limited. Therefore, LDOM could be an important addition to the available therapies for managing some hair disorders, including AGA.
... In August 2022, The New York Times (NYT) reported on the potential benefits of LDOM for hair loss, which was shared widely on multiple social media platforms and was one of the ten most read NYT articles of the year [1][2]. The article cited an observational study [3], included before and after photos, and quoted dermatologists who recommend LDOM. Physicians at our organization noticed an immediate, widespread increase in patient requests for LDOM. ...
... We initially retrieved 452 records, of which 207 were duplicates, to end up with 245 studies for the title and abstract screening. After excluding 231 studies in the first screening stage, 14 papers passed to full-text screening, to end up finally with five studies [5,[12][13][14][15]. The search and screening process is summarized in Figure 1. ...
... The dosing regimen and treatments used were also variable across studies ( 15) in the monotherapy. One study used the Women's Alopecia Severity index [15], the Sinclair grading score in three [5,13,14], and the Ludwig scale and the midscalp clinical grading scale in one [12]. However, there was a significant overall heterogeneity (I2=75%; P-value=0.003), ...
... The overall rate of improved hair loss [12][13][14][15] The hair loss did not improve or showed a modest improvement in 37.80% (95% CI=24.88-52.71) of all patients. Further subgroup analysis showed that the rate was 31.93% (95% CI=17.17-51.49) in the combined therapy and 46.73% (95% CI=30.93-63.21) in the monotherapy. ...
Oral spironolactone has been proposed as a potential treatment for hair loss due to its antiandrogenic properties. However, the efficacy and safety of spironolactone for treating hair loss are not well-established.
The objective of this study was to conduct a systematic review of the current literature on the use of oral spironolactone in female pattern hair loss.
We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies that assessed the efficacy and safety of oral spironolactone for treating hair loss. We searched for eligible papers in PubMed, Web of Science (ISI), Embase, and Scopus. All analyses were done using R software version 4.2.3 (R Foundation for Statistical Computing, Vienna, Austria).
The overall rate of improved hair loss was 56.60%, with a higher rate of improvement (65.80%) observed in the combined therapy group compared to the monotherapy group (43.21%). However, there was significant heterogeneity in the efficacy outcomes, and hair loss did not improve or showed a modest improvement in 37.80% of all patients. The rates of adverse events reported in at least two studies were scalp pruritus or increased scurf (18.92%), menstrual disorders (11.85%), facial hypertrichosis (6.93%), and drug discontinuation (2.79%). The overall adverse events rate was 3.69%, but there was significant heterogeneity in the rates of different adverse events.
In conclusion, the present study suggests that spironolactone is an effective and safe treatment option for hair loss. However, further research is needed to fully understand the heterogeneity of treatment response and adverse events and identify factors that may predict treatment response.
