Topical minoxidil for male androgenetic alopecia or female pattern hair loss

Topical minoxidil can be used as monotherapy for mild to moderate male androgenetic alopecia or female pattern hair loss. It can also be used in combination with oral treatment (finasteride in males, or spironolactone in females) for more severe cases, or in mild to moderate cases if the patient requests initial combination therapy.

Topical minoxidil is available as a foam or lotion. The foam is available as minoxidil 5%, and the lotion is available as minoxidil 2% and 5%. The foam is less irritating and less likely to cause allergic contact dermatitis, and is less greasy than the lotion, so is more acceptable cosmetically.

Topical minoxidil may aggravate scalp eczema, seborrhoeic dermatitis and dandruff—ensure these conditions are treated before starting topical minoxidil.

For male androgenetic alopecia or female pattern hair loss, if treatment is requested, use:

Assess efficacy after 6 to 12 months.

Advise the patient to apply minoxidil with care near the forehead and temple because of the risk of hypertrichosis. Reassure the patient that it is normal for hair shedding to increase in the first 4 to 6 weeks of treatment; this reactive shedding settles after a few weeks.

Adherence to therapy may be limited because minoxidil must be applied daily; cost may be a consideration. If adherence to topical minoxidil therapy is unlikely, consider oral finasteride in males, or spironolactone in females.