Minoxodil Therapy – Topical & Oral Minoxidil
Topical Minoxidil (Minoxildil in solution applied to scalp directly)
Topical minoxidil applied to the scalp is a mainstay treatment of Male and Female Pattern Hair Loss (MPHL & FPHL). The advantage is that it can be relatively easily applied to the scalp. Absorption of topical minoxidil is minimal (studies show 1-2%). It is therefore a relatively safe and effective treatment.
The disadvantage with topical minoxidil is that it must be applied continuously and it is less potent when compared with oral minoxidil. It can take 3-6 months to observe the stimulatory hair growth effects of minoxidil.
Male and Female Pattern Hair Loss are longterm (chronic) conditions so application is continued in the longterm and therefore requires daily time and effort as a result.
Studies show the most common issue among all patient is compliance with topical Minoxidil treatment. After 12 months of the treatment 86.3% of patients will discontinue the treatment. Discontinuation rate showed no association with sex.
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This discontinuation problem is cyclical. Once benefits of topical treatment are seen and hair density improves, patients relax with their application routine. This then triggers a reduction in hair density as male and female pattern hair loss are longterm conditions. Once the density of hair drops patients will start to notice and attempt to restart the topical therapy. At each subsequent restart of topical minoxidil the patient will experience an initial shedding in the first three months. This is a potentially worrying time for patients. This is another reason why topical minoxidil therapy compliance is very important.
Oral Minoxidil is more potent in its effect versus topical. The key reason for lower potency of topical minoxidil is that the actual active ingredient in the topical minoxidil liquid cannot penetrate the outer layer of the skin easily. The outer layer of the scalp or epidermis acts as a barrier to absorption. As the target cells for hair growth lie deep within the dermis only a fraction of the active ingredient will arrive at its target. This problem can be overcome by increasing the concentration of the solution applied but doing this can often cause other side effects such as redness irritation and swelling (irritant dermatitis).
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Oral Minoxidil (Minoxidil taken in tablet form)
Efficacy of oral minoxidil outweighs that of Topical minoxidil. Oral minoxidil is taken in a tablet form. The advantage is that the hair growth stimulating benefits of the drug when taken as a tablet or capsule are more potent.
It is always better to be on oral minoxidil as it is more potent and also much easier to take as a tablet. So compliance with your hair loss medication is a very easy process. Applying a scalp lotion once or twice a day takes time and eventually becomes quite cumbersome. Applications are omitted accidentally or because of the time-consuming and messy nature.
Taking a tablet is quick and easy. It is not surprising that as professionals we find that oral tablet form minoxidil is more effective by virtue of its more potent effect and due to easier and more consistent patient compliance with the medication regimen.
When taking tablet form minoxidil hair growth stimulation is more potent. However, side effects can be encountered. Minoxidil was originally developed as a medication to reduce blood pressure. In tablet form it can cause blood pressure to be lowered. It can also cause light headedness and swelling of extremities and rapid heartbeat.
In women excessive facial and body hair growth are also encountered at higher doses. This can be a significant nuisance and leads to discontinuation of therapy. It is especially important to have patient specific dosing in women and female pattern hair loss.
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Patient Specific oral minoxidil formulation
When oral minoxidil is used in hair loss therapy it is a specially formulated low dose.
Most minoxidil when prescribed by you regular GP or dermatologist is given at the lower licensed doses that are originally manufactured for the management of high blood pressure. This is typically 10mg, 5mg or 2.5mg tablets.
At these higher doses especially in women undesirable facial and body hair growth can result. Women will obviously appreciate oral minoxidil hair growth stimulatory effects in female pattern hair loss.
Unfortunately, most females will be very disappointed when routine high dose minoxidil therapy results in excess facial hair growth and unwanted excess bodily hair.
These side effects may then push women to commence laser hair removal treatment to counteract the unwanted hair. Laser Hair Removal may then lead to paradoxical hypertrichosis (greater hair growth instead of removal) and this unwanted side effect is especially common on the female face. It is also very difficult to manage if it does occur. It is natural for women to not want excess facial hair.
Appropriate formulation with control of the oral dose is especially important in women for these reasons. Women also report a greater frequency of headaches (7% of female patients taking oral minoxidil for female pattern hair loss) when on higher dose oral minoxidil. Patient specific dose formulation helps to eliminate this side effect in both women and men.
Oral Minoxidil is formulated and dosed in a patient specific manner.
Your Hair Loss Specialist takes into account the following before specially formulating the correct oral dose of minoxidil:
- Sex
- Weight
- Hair loss diagnosis
- Hair loss blood test screen
- Biopsy result
- Other medical conditions
- Other regular medications that you take
Once the above factors have been taken into account, your Hair Loss Specialist will order up a specially formulated dose of minoxidil from our compounding pharmacy partner.
This dose will typically be variable but designed for greatest efficacy with minimal side effects.
It is important to understand that normally prescribed minoxidil tablets are only available in a minimum dose of 2.5mg tablets. This is already well above the highest recommended daily dose for women. It is therefore extremely important to have oral minoxidil specially formulated for women in the treatment of female pattern hair loss (FPHL). This is best practice but unfortunately due to the lack of Hair Loss Treatment Centres that formulate patient specific minoxidil it is difficult to source and access this type of service in the UK.
Men also benefit from appropriate patient specific formulation as it allows for the optimisation of hair stimulation in male pattern hair loss without induction of unnecessary side effects.
As a centre of excellence we aim to always adopt best practice for our patients and as a consequence we offer this service. Your response to oral minoxidil therapy will also be monitored at regular intervals and dose regimen can be modified accordingly. Other topical medications and therapies can be prescribed and performed in conjunction with oral minoxidil therapy. These treatments will be prescribed and safely performed under routine monitoring by your Hair Loss Specialist. These treatments may include:
- Platelet Rich Plasma Injection Therapy (PRP intradermal Scalp Injection)
- Dutasteride Intradermal Scalp Injection Therapy
- Topical Finasteride
- Oral Finasteride therapy
- Scalp microneedling / PRP combined therapy
Your Hair Loss Specialist will discuss the best and safest therapeutic options for you once you have been seen following your initial hair loss screening consultation.
Topical Minoxidil / Finasteride Formulations used
Many formulations of minoxidil are cheaply and readily available online. These use minoxidil that is dissolved in alcohol or propylene glycol. Alcohol and propylene glycol are ingredients known as excipients. Minoxidil is the active ingredient. Alcohol or propylene glycol are excipients.
Alcohol and propylene glycol are useful to manufacturers of these products as minoxidil can easily be dissolved into a solution form using these ingredients. At the same time alcohol and propylene glycol cause significant drying of the scalp. They are also potent irritants of the skin of the scalp.
As a result using these commonly available cheaper formulations regularly cause dryness, irritation, inflammation and contact irritant dermatitis of the scalp. Worsening dandruff and aggravation of scalp conditions such as seborrheic dermatitis are seen often with these formulations. All these factors eventually lead to discontinuation of treatment and further hair thinning and loss.
We use specially formulated minoxidil solution that uses a special base called Trichosol, Trichosol has been specially developed to assist with effective transdermal penetration of minoxidil solution whilst being minimally irritant and drying to the skin of the scalp.
Trichosol is a far superior drug delivery vehicle when compared with alcohol and propylene glycol. This is why topical formulations prescribed by your Hair Loss Specialist will be in given if necessary in a trichosol base.
This is how we optimise your topical hair loss treatment and minimise side effects and help with maintaining easy compliance.
Following your initial hair screening and consultation your Hair Loss Specialist will prescribe the appropriate topical medication in the appropriate base. These can be safely used in conjunction with your other oral or injectable therapies that include:
- Platelet Rich Plasma Injection Therapy (PRP intradermal Scalp Injection)
- Dutasteride Intradermal Scalp Injection Therapy
- Oral Finasteride therapy
- Scalp microneedling / PRP combined therapy
Advantages of Trichosol Base (TRICHOSOLTM BASE manufactured by FAGRON)
We use often Trichosol in our topical products. Trichosol is a trademarked vehicle that has been specially designed for the optimisation of topical scalp applied medications such as minoxidil.
The key benefits are that Trichosol is alcohol and propylene glycol free. As a result, inflammation and contact irritant dermatitis side effects are minimised. Patients can remain dandruff free and minimise flare up of scalp conditions such as seborrheic dermatitis, This facilitates regular and effective compliance with topical medication usage by patients.
Trichosol does not result in scalp dryness.
The Trichosol vehicle itself helps transdermal drug absorption and maintains an extracellular environment that promotes transport of the active ingredient (such as minoxidil or finasteride) to the target cells.
It has a proven track record in safety and compliance when used for the formulation of topical scalp medications.
One of the ways we maximise efficacy, ease of use and patient compliance when prescribing topical medications is by using Trichosol Base. Optimisation of hair growth is our aim. Right down to the vehicle solution we use for manufacture of our products.
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Summary of Oral and Topical Minoxidil Side Effects
| Oral Minoxidil | Topical Minoxidil | |
| Scalp irritation | None. Preferred treatment for those with sensitive scalp or scalp issues | Common |
| Easy to use | More convenient resulting in high compliance | High dropout rate of 86.3% due to daily application of the topical solution, form or cream onto the scalp resulting in hair shedding of all new regrown hair on discontinuation |
| Increased facial or body hair | More pronounced, that can be managed by Laser hair removal | Significantly less as absorption into blood steam is limited in topical application |
| Fluid retention; oedema | Common, managed by lowering the dose | Unlikely |
| Tachycardia | Common, managed by lowering the dose | Uncommon |
| Headache | Common, managed by lowering the dose | Uncommon |
What kind of DHT blockers can be added to topical Minoxidil preparations?
• Topical (liquid) form of Finasteride
• Caffeine
• Azelaic Acid
• Biotin
• Estradiol
• Request your preferred DHT blocker or a mixture
Why is our approach different or better?
- The approach of treatment is highly focused on correct diagnosis and finding any triggering factors or accelerators, using methods like trichoscopy, visual examination, blood tests and biopsy.
- Compliance is another biggest focus when we treat chronic conditions with Minoxidil. Many chronic conditions require ongoing maintenance, the compliance and convenience of the treatment regimen are highly important.
- All the medications are individually made to tailor the need of each patient to maximise the efficacy and to minimise side-effects.