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Dermatol Surg. 2002 Oct;28(10):894-900.
The potential role of minoxidil in the hair transplantation setting.
Avram MR, Cole JP, Gandelman M, Haber R, Knudsen R, Leavitt MT, Leonard RT Jr, Puig CJ, Rose PT, Vogel JE, Ziering CL; Roundtable Consensus Meeting of The 9th Annual Meeting of The International Society of Hair Restoration Surgery.
Department of Dermatology New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA.
MINOXIDIL
In 1979 oral minoxidil was approved for the treatment of patients with severe hypertension. 3 Reports of increased body hair growth in many of the patients using this antihypertensive preparation led to clinical development of a topical formulation of the drug. Minoxidil 2% topical solution via prescription was approved by the FDA for the treatment of androgenetic alopecia in men (1988) and women (1992). In 1996, minoxidil 2% solution was approved for over-the-counter use in men and women with androgenetic alopecia. Subsequently, in 1997, minoxidil 5% topical solution was approved for nonprescription use in men with androgenetic alopecia. 3
Although its exact mechanism of action remains unknown, topical minoxidil may act as a nonspecific biologic response modifier. The vasorelaxant effect of minoxidil sulfate, the active metabolite of minoxidil, results primarily from opening potassium channels. 11,12 However, the mechanism of action of topical minoxidil with respect to the stimulation of hair growth appears to be independent of vasodilation. 3 Minoxidil topical solution acts directly to enlarge miniaturized follicles and the diameters of the hair shafts they produce. Telogen hair follicles are converted to anagen hair follicles, and the anagen phase of hair growth is prolonged, thus slowing the progression of hair loss. 3 Although the growth phase may be prolonged, the follicle will continue to cycle, thus several months' use (up to 1 year) may be necessary before optimum potential hair growth is achieved. An important factor that favors regrowth is the presence of a large number of partially miniaturized follicles that are still producing hair 3/8 inch or more in length.
Studies of minoxidil topical solution in men and women have demonstrated significant increases in both hair count 13 and hair weight 8,14 compared with a vehicle placebo control, with the minoxidil 5% solution significantly more effective than the 2% solution in male subjects. 13 Recently Rundegren and Trancik 15 evaluated the effects of minoxidil 5% and 2% topical solution on stabilization of hair loss in men and women with androgenetic alopecia. Stabilization was defined as a combination of unchanged hair status and hair regrowth. This retrospective analysis was based on comparative data obtained from four randomized, double-blind, placebo-controlled trials (n = 1054) and from a major postmarketing surveillance study. The stabilization response (ie, the percentage of patients who had unchanged hair growth or regrowth) varied from 87 to 88% in female studies of minoxidil 2% (n = 438) and 75 to 96% in male studies of minoxidil 5% (n = 616) (Table 1). Both concentrations of minoxidil topical solution were significantly superior to placebo. The response rates noted in placebo patients is likely due to the excipient propylene glycol. Data from the postmarketing surveillance study found that 80% (n = 11,000) of patients being treated with minoxidil 2% topical solution reported a diminished rate or stopping of hair loss. 15 Studies focusing on other indications of hair loss, although not approved in the product labeling, have shown that minoxidil stimulates hair regrowth in patients with patchy and extensive alopecia areata and reduces the duration of alopecia caused by chemotherapy. 16,17
Several studies have examined the use of minoxidil as an adjunct to hair transplantation surgery in men with androgenetic alopecia. 1820 In an uncontrolled study of 12 male patients with androgenetic alopecia, minoxidil 3% topical solution was administered twice a day to the transplant area starting 48-72 hours after hair transplant surgery. 18 Two patients demonstrated hair growth without the usual shedding 2-4 weeks after surgery and two additional patients had regrowth within 4 weeks after postsurgical telogen effluvium. This is far sooner than the typical 3-5 months.
In another uncontrolled trial of 16 male hair transplant patients with androgenetic alopecia, 19 minoxidil 2% was administered for 4 weeks prior to surgery, interrupted for 3 weeks, then restarted and continued for 3 months after surgery. The study found that in 71% of grafts, partial or total hair was still growing without the usual shedding that occurs 2-4 weeks after surgery.
The effectiveness of administering minoxidil prior to hair transplant surgery was also reported by Roenigk and Berman. 20 In this double-blind trial, 12 males with androgenetic alopecia were randomized to have either minoxidil 2% topical solution or placebo applied to the donor area for 6 weeks prior to transplantation and to recipient areas for 17 weeks after surgery. After 17 weeks, significantly less grafted hair was lost by minoxidil-treated patients compared with placebo-treated patients (22% versus 52%; P = .001).