Medications serve an important role in both the prevention and treatment of hair loss, particularly in the early stages of the balding process. Rogaine (minoxidil) can be useful for early hair loss by stimulating hair growth, but it is generally not as effective as the oral medication Propecia (finasteride). Because medical therapy works to thicken hair in areas that are thinning (miniaturized), rather than to grow hair once it is lost, medical treatment is best started as soon as the thinning is noted.
Rogaine (minoxidil) is the only FDA approved topical solution for the treatment of hair loss. It is applied directly to the scalp and can be purchased without a prescription. It is believed to work by increasing the length of time of the anagen or growth phase of thinning (miniaturizing) hairs. Rogaine was developed after the oral blood pressure medication minoxidil (Loniten) was noted to grow hair.
Minoxidil works best in the crown area but as long as there are existing fine hairs, patients may also see benefits to a lesser degree in the front of the scalp. Minoxidil does not work in areas that are completely bald. The drug serves to thicken already existing hair, rather than to grow new hair.
Minoxidil is applied directly to the affected areas of the scalp twice a day. It can now be purchased without a prescription and in generic formulations in a 5% solution or foam for men and 2% solution for women. The full results of the medication may not be seen for 6 to 12 months. The Minoxidil 5% contains propylene glycol which may irritate the scalp and leave hair feeling sticky. The Rogaine foam is in a glycerin and alcohol base and does not have the same drying effects as the original minoxidil solution and has a less sticky consistency. However, some find the foam harder to apply directly to the scalp, particularly when the person has a significant amount of hair.
Minoxidil does require some commitment. If minoxidil is stopped, the effects of the drug will wear off within three months and the person will revert to the previous pattern of hair loss. If Minoxidil is restarted, the patient usually does not regain the hair that was lost, so it is best not to stop and start the mediation, but to use it regularly.
If Minoxidil is prescribed (off-label) in conjunction with other medications, such as topical retinoic acid (Retin-A), to enhance the penetration into the skin and increase its effectiveness, it can also greatly increase the absorption of minoxidil into the bloodstream and cause systemic side effects. These side effects can include changes in blood pressure. The combination can also cause severe scalp irritation.
Besides the possibility of causing scalp irritation in both men and women, the development of facial hair can be a particular problem in female patients. Women should be careful when applying minoxidil, ensuring that it does not drip down the temples and forehead, but this does not always prevent the development facial hair. Although the facial hair slowly resolves when the medication is discontinued, at times the hair may need to be removed.
Robert M. Bernstein M.D., F.A.A.D.
Clinical Professor of Dermatology
College of Physicians and Surgeons of Columbia University
New York, New York
Bernstein Medical Center for Hair Restoration
110 East 55th Street, 11th Fl., New York, NY 10022