Overview
Minoxidil is most popular treatment for both Female Pattern Hair Loss and Male Pattern Hair Loss. It was first found in 1970s and was used as a potent peripheral vasodilator agent for the treatment of severe refractory hypertension. Since 1987 it was mostly used for androgenic alopecia, first for males and later for females. It is used for:
- Male Pattern Hair Loss
- Female Pattern Hair Loss
- Alopecia Areata
- Chemotherapy-induced alopecia
- For scarring alopecia as supportive treatment
- Hereditary alopecia or hypotrichosis
Minoxidil affects the potassium channels, that increases microcirculation around the hair follicles. That results in arteriolar vasodilation, meaning increase a blood flow to the follicles.
Minoxidil induces the vascular endothelial growth factor expression, this results in increase vascularisation around the follicle.
Minoxidil activates the prostaglandin-endoperoxide synthase-1 enzyme, that leads to the enhancement of hair growth. It also acts as epidermal growth factor on the matrix cells. This increases growing anlagen stage of the hair follicle. It is achieved through the activation of the beta-catenin pathway.
Furthermore, Minoxidil impacts in collagen systems having anti fibrotic characteristics. Last but not least, it inhibits androgen-related affects.
Why Minoxidil is so popular?
Minoxidil is very affordable treatment for most of the patients. It can be purchased even without prescription though the pharmacy, preparations like Minoxidil liquid or Minoxidil foam. For higher grade of Minoxidil preparation patients can come to the hair loss clinics, that offer extemporaneously (freshly made to each patient order) preparations. Some clinics offer various percentage of Minoxidil liquid and mixed preparations with DHT blockers. All fully customised to the patient’s need. More exclusive hair loss clinics also offer various base of the preparation, for example alcohol-free, propylene glycol free, with less preservatives, water base that will be less irritant to the scalp.
Minoxidil preparations are also available as a capsule on the prescription with a tailored dose to the patient, which is more convenient to take.
Minoxidil liquid, foam and capsules show great results with low cost.
So why so many patients refuse Minoxidil treatment?
There is only one simple reason for this. When you stop Minoxidil treatment then your hair gain reverses to the original state at the time when you stop the treatment.
When you start on Minoxidil treatment either liquid or capsules, there is an initial shedding stage. This happens because of change of the hair cycle. The growing stage of the hair becomes longer and the falling stage becomes shorter. This is why you gain more hair through increase in anlagen stage. So when you stop the treatment the hair cycle changes again and the falling (telogen) phase reverses to your original longer phase. In practice it express in hair shedding and hair thinning, so you will loose the volume through shedding. The diameter of the hair and the number of hairs that come out of each follicle will also reduce. As I mentioned before this is because Minoxidil increases a growing phase and also improves the blood flow, so the quality and the density of the hair also improves.
From practice, non of the patients consider stopping the treatment when they start on the treatment. After a while most patients get bored to apply Minoxidil liquid on daily of twice a day basis for the rest of your life. Also, it can be a financial burden or other priorities and distractions in life come into place. Other very common reason why patients stop using Minoxidil is due to Contact Dermatitis. Contact Dermatitis is an irritation of the scalp due to Minoxidil liquid applications. It is expressed through symptoms of itchy and irritated scalp which causes a great discomfort. As a result, the patient will stop the treatment eventually.
To improve adherence to the Minoxidil, I advice to use Minoxidil capsules. It is more convenient form of Minoxidil to use and clinically it shows better results.
So what is the alternative treatment to Minoxidil?
Note that due to mode of action of Minoxidil, I do not include DHT blocker treatment. DHT blockers will be a complimentary treatment to minoxidil not a substitute.
I would suggest to look into hight quality of PRP treatment, especially PRF with high outcome of platelets and growth factors of >3billions to be effective.
Also, exosomes for hair loss is an emerging treatment available now. However, there is still various manufacturing process of extracting exosomes, no standardisation and various clinical results. Saying that, there are some that show promising results. The cost is high for high quality exosomes that may deter many patients.
Another alternative is emerging treatment called. Calecim. It contains high dose of growth factors and can be used as a clinical procedure or at home. The clinical procedure is more effective due to delivery system with Dermapen or Lazer. At home patients can use it with dermastamp.
Microneedling is another home procedure that aims to release growth factors through wound heeling. However, the PRP or exosomes procedure in clinic will deliver significant higher amount of growth factors.