Annoyed by That Bald Spot?

When hair loss occurs in the course of our natural lives, it is acceptable to many of us - just another sign of getting older.  On the other hand, some men and women are significantly embarrassed and disturbed by it. Dermatology hair loss experts recently convened an international consensus panel of 43 specialists from 12 countries to agree on a safe and effective treatment.  Consensus was reached if 70% or more agreed or strongly agreed on the guidelines for patients 12 and older.

Topical minoxidil (Rogaine®) is an FDA approved treatment that helps to regrow hair and prevent future hair loss.  Although it is available over the counter, it should not be used without the knowledge and advice of your physician.  It usually takes 2-4 months of use to start working for small hairs to appear and 4-6 more months for visible, thicker hair growth to become visible.  For treatment to succeed, you must be committed to daily use.  Side effects of the topical treatment may include scalp irritation, unwanted facial hair, warmth and redness. Sometimes systemic symptoms like rapid heart beats, swelling of hands and feet, light-headedness, headache and chest pain have occurred.  The drug has been used orally to treat high blood pressure in doses of 10-40 mg daily and interestingly, a side effect is excessive hair growth.

Low dose oral minoxidil (LDOM) has become an increasingly popular off-label treatment for patients with hair loss. Research groups have reported on the off-label use of LDOM, ranging from 0.25 mg to 5.0 mg daily, as a safe and effective treatment option for male and female patients with AGA, age-related patterned thinning.  Experts agreed that LDOM may be favored over topical minoxidil when LDOM is less expensive; is more convenient; when topical minoxidil causes styling issues, undesirable product residue, or hair texture change; when topical minoxidil coincides with scalp inflammation; and if topical minoxidil results in an ineffective or plateaued response. Blood pressure monitoring is recommended during the use of LDOM.

           This consensus statement contributes substantially to the current understanding of LDOM prescribing for patients with hair loss, providing a solid foundation for clinical practice.  LDOM is not for everybody, but it is appearing as a “new” treatment.  Those seeking treatment for hair loss should consult their physician for referral to a dermatologist with experience in hair loss therapies.

Medical Tip from Charles Driscoll, VASSAR Surgeon General

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Reference: Akiska YM, Mirmirani P, Roseborough I, et al. Low-Dose Oral Minoxidil Initiation for Patients With Hair Loss: An International Modified Delphi Consensus Statement. JAMA Dermatol. 2025;161(1):87–95. doi:10.1001/jamadermatol.2024.4593

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