A once-daily oral minoxidil pill can work at least as well as, and at the crown possibly better than, the standard topical liquid/foam -- a reasonable option under medical supervision for men who find the topical messy, irritating, or inconvenient, though it trades scalp irritation for a higher chance of unwanted hair growth elsewhere and headaches.
What they did
Men aged 18-55 with moderate androgenetic alopecia were randomized to oral minoxidil 5 mg/day plus a topical placebo, or topical minoxidil 5% twice daily plus an oral placebo, for 24 weeks. Hair density was measured by trichoscopy and blinded dermatologists scored standardized photographs.
What they found
No significant difference between groups in the frontal scalp area (P=.27). At the vertex (crown), the oral group gained 21.6% more terminal hair versus a -5.6% change with topical (P=.005); photographic assessment favored oral at the vertex (P=.04) but not frontally. Hypertrichosis (unwanted body/facial hair) was more common with oral (49% vs 25%, P=.02); headache was more frequent with oral (14% vs 2%); scalp irritation/eczema was more common with topical (16% vs 2%). No significant blood pressure or heart rate changes were seen. Only 4 participants (1 oral, 3 topical) stopped due to side effects.
Limitations
Single-center study; relatively small and underpowered; 25% dropout (partly pandemic-related); only 24 weeks of follow-up; no women included; results may not generalize beyond the doses tested.
Who paid for it
Brazilian Dermatology Society Support Fund (FUNADERM); no pharmaceutical industry funding disclosed
Read the original
Oral Minoxidil vs Topical Minoxidil for Male Androgenetic Alopecia: A Randomized Clinical Trial ↗ · Penha MA, et al. · DOI 10.1001/jamadermatol.2024.0284
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