Award-Winning Research on Hair Loss Consensus Highlighted at Annual Meeting

A poster highlighting the results from an international consensus on hair loss won 4th place for its work in supporting patients, colleagues, and the community at the 2024 American Academy of Dermatology Annual Meeting.

“Low-Dose Oral Minoxidil Initiation and Monitoring (LOMI) For Hair Loss: A Modified Delphi Consensus of Experts,” brought together dermatologists with experience and expertise in research, clinical practice, and professional societies to review current literature on the use of low-dose oral minoxidil (LDOM) for hair loss.¹ Currently, topical minoxidil is approved for androgenetic alopecia, and it is used off-label for other hair loss disorders. In cases in which the drug is ineffective, logistically challenging, or there are tolerability issues, low dose minoxidil has become a popular practice.² Because larger trials looking at this use is limited, the poster authors sought to develop expert consensus-based guidelines.

“LDOM can be considered when [topical minoxidil] is more expensive, logistically challenging, has plateaued in efficacy, results in undesirable product residue/skin irritation, or exacerbates inflammatory process (i.e. eczema, psoriasis etc.),” the authors shared based on the consensus findings. The consensus noted efficacy is generally demonstrated between 3 to 6 months into treatment, with daily dosing ranging from 0.625 to 2.5 mg for adolescent (12 to 17 years) females, 0.625 mg to 5 mg daily for adult females, and 1.25 mg to 5 mg for both adolescent and adult males.

The consensus advocates for specialty consultations only when potential contraindications (drug hypersensitivity, significant drug-drug interaction, history of cardiac complications, pheochromocytoma, renal impairment, dialysis, and pregnancy/breastfeeding. The consensus recommends monitoring for adverse effects during treatment initiation as well as whenever dose escalation occurs for potential indications of trouble, including lightheadedness and dizziness; chest pain; shortness of breath; abnormal heartbeats; swelling in feet, legs, or face; and weight gain.

According to the consensus report, patients with androgenetic alopecia, age-related patterned thinning, alopecia areata, telogen effluvium, traction alopecia, persistent chemotherapy-induced alopecia, and endocrine therapy-induced alopecia would see a direct benefit from LDOM. The results also indicated supportive benefit for patients with lichen planopilaris, frontal fibrosing alopecia, central centrifugal alopecia, and fibrosing alopecia in a patterned distribution.

Dermatology Times chatted with lead investigator Jennifer Fu, MD, assistant clinical professor of dermatology and director of the Hair Disorders Clinic at the University of California at San Francisco, about the poster and the group’s important work.

Jennifer Fu, MD

Dermatology Times: Tell us about the research and what inspired you and your colleagues to address the issue?

Jennifer Fu, MD: Hair loss is incredibly common, significantly impacts our patients’ lives, and can be secondary to a variety of causes.

Topical minoxidil is an over-the-counter drug, FDA-approved agent used to treat the most prevalent form of hair loss—androgenetic alopecia (AGA). It is also used off-label for a number of other types of hair loss. Although topical minoxidil is safe and effective, patient adherence can be poor. Patients often find topical minoxidil challenging to apply. They report that it leaves an undesirable residue and can have a drying effect on their hair and skin. Topical minoxidil can also cause irritant or allergic contact reactions.

All of these factors has led to the growing popularity of low-dose oral minoxidil (LDOM) for the treatment of hair loss. Oral minoxidil is a peripheral vasodilator, originally FDA-approved in the 1970s for the treatment of severe refractory hypertension. Interestingly, a significant side effect of oral minoxidil was hypertrichosis, which led to the investigation of topical minoxidil as a hair growth agent.

Although oral minoxidil is no longer a first-line antihypertensive agent due to potential cardiovascular adverse effects at antihypertensive doses(10 mg - 40 mg daily), there are an increasing number of case reports and case series documenting the use of LDOM at doses ranging from 0.25 mg to 5 mg daily as a safe and effective option for various types of hair loss, such as male and female AGA, age-related patterned thinning, traction alopecia, and alopecia areata.

This literature correlates with a parallel increase in LDOM prescriptions written by dermatologists in recent years, as well as the proliferation of oral minoxidil prescriptions obtained in the digital-consumer telemedicine health care sector. In light of this and the current absence of larger trials on this topic, our research group identified a strong need for expert-based guidelines for prescribing and monitoring LDOM use in hair loss patients, with the goal of maximizing hair growth and minimizing potential cardiovascular adverse effects.

We reviewed existing pharmacologic data on oral minoxidil and clinical reports of LDOM for hair loss. We then recruited a panel of dermatologists with hair loss expertise and engaged in a 4-round modified Delphi consensus process to produce best practice guidelines regarding LDOM use in hair loss patients.

Dermatology Times: What are some of the challenges in addressing hair loss in patients?

Jennifer Fu, MD: Hair loss, as we all know, is deeply personal and impacts our sense of self, as well as our sense of community membership. We use hair to express everything about ourselves—our personal style, gender, sexuality, cultural and ethnic heritage, as well as religious and political affiliations.

Addressing the needs of patients with hair loss requires a comprehensive approach and partnerships both within and outside of medicine. When it comes to hair loss, in order to treat the whole patient, you often must work collaboratively with a diverse group of allies—basic science partners, medical colleagues in other specialties, pharmacy specialists, insurance specialists, patient advocacy groups, industry representatives, and state and federal legislators.

"Addressing the needs of patients with hair loss requires a comprehensive approach and partnerships both within and outside of medicine."

Dermatology Times: What do you see as the future in treating hair loss?

Jennifer Fu, MD: I am incredibly excited about recent advances in our understanding of the immunology of the hair follicle and the various biochemical signals that impact the hair cycle. Much of this work has originated from a focus on 1 particular disease state, alopecia areata, but I am hopeful that these foundational concepts will extend beyond a single disease and lead to a more sophisticated approach to other types of non-scarring and scarring alopecia.

Dermatology Times: Is there anything else you would like your colleagues in dermatology to know about your award-winning poster or hair loss treatment?

Jennifer Fu, MD: We hope that these guidelines will be helpful to our colleagues who are interested in using LDOM to treat hair loss in their adult and adolescent patient populations. We anticipate that these recommendations will be updated as additional evidence-based data emerges. We also encourage our pediatric dermatology colleagues to investigate best practices for LDOM in pediatric patients.

1. Akiska YM, Mirmirani P, Roseborough I, et al. Low-Dose Oral Minoxidil Initiation and Monitoring (LOMI) For Hair Loss: A Modified eDelphi Consensus of Experts. Presented at 2024 AAD Annual Meeting; March 9, 2024; San Diego, California. Accessed March 8, 2024. https://aad-eposters.s3.amazonaws.com/AM2024/poster/50804/Low-Dose+Oral+Minoxidil+Initiation+and+Monitoring+LOMI+For+Hair+Loss+A+Modified+Delphi+Consensus+of+Experts.pdf.

2. Rajab F. Low-dose oral minoxidil for hair growth. Dermatology Times. 2022; 43(11):38-39.