Daily oral minoxidil, 5 mg was not superior to topical minoxidil, 5%, in a population of male patients with alopecia according to a new study in JAMA Dermatology.  

"There has been increased interest in low-dose oral minoxidil for androgenetic alopecia (AGA) treatment," the authors wrote of their paper. "However, the efficacy of oral minoxidil for male AGA is yet to be evaluated in comparative therapeutic trials."

Researchers designed and conducted a double-blinded, placebo-controlled randomized trial (single-center) that included 90 male patients (68 to study completion) with AGA aged 18 to 55 years classified using the Norwood-Hamilton scale as 3V, 4V, or 5V. Patients were randomized 1:1 and treated with either daily oral minoxidil, 5 mg (vs. topical placebo solution), or 1 mL twice-daily topical minoxidil, 5% (vs. oral placebo), for a period of 24 weeks, with a primary outcome of change in termanal hair density on the frontal and vertex regions of the scalp. 

Among the key findings over the 24-week study period:

• Frontal area - Mean change from baseline: 3.1 hairs per cm² (95% CI, −18.2 to 21.5; P = 0.27) for terminal hair density and 2.6 hairs per cm² (95% CI, −10.3 to 15.8; P = 0.32) for total hair density
• Vertex area - Mean change from baseline: 23.4 hairs per cm² (95% CI, −0.3 to 43.0; P = 0.09) for terminal density and 5.5 hairs per cm² (95% CI, −12.5 to 23.5; P = 0.32) for total hair density
• Oral minoxidil was superior to topical minoxidil on the vertex (P = 0.04), but not frontal scalp (P = 0.24).
• Almost half of the patients (49%) in the oral minoxidil group reported hypertrichosis as an adverse effect, and 14% reported headaches. 

"Low-dose oral minoxidil (5 mg per day) had similar efficacy to topical minoxidil, 5%, for men with androgenetic alopecia and can be an option for patients who prefer oral therapy or are intolerant to topical treatment," the authors wrote. 

Source: Penha MA, et al. JAMA Dermatology. 2024. Doi:10.1001/jamadermatol.2024.0284