Rogaine (minoxidil)

with Michael I. Jacobs, MD

In each issue, Practical Dermatology® asks top dermatologists about the newest products they are recommending to patients. Here, Michael I. Jacobs, MD, an associate professor of dermatology at Weill Cornell Medical College in New York City and Medical Technology Director for the teledermatology platform Cortina, spoke to us about how he is using Rogaine (minoxidil) on its own and with other therapies to treat hair loss.

How does Rogaine work?

Michael I. Jacobs, MD: Rogaine (minoxidil) is a topical treatment for stimulating hair growth. It works by allowing more blood, oxygen, and nutrients to access the hair follicles by opening up the blood vessels where it is applied. It can also stimulate growth by improving the cell’s ability to produce a protein that extends the hair’s active growth phase. Topical Rogaine is available over the counter and by prescription. Oral minoxidil must be prescribed by a physician.

Who makes an appropriate patient?

Dr. Jacobs: Most people with hair loss and slowed growth can be appropriate candidates for Rogaine. This can include people with hair loss from aging, female- or male-pattern hair loss, hormonal or seasonal hair loss, or other reasons. Rogaine isn’t effective when the hair follicle is no longer present. This can happen with inflammatory hair loss disorders such as scarring alopecias.

What results are possible, and how quickly?

Dr. Jacobs: Within 3 to 4 months, some patients will begin to see improvements in the rate of their hair growth or a decline in their hair loss. For optimal results, most patients will have to wait 48 weeks to see stark improvements. Results will differ from person to person, and it can be difficult to predict who will receive the most effective results.

What do you combine Rogaine with for hair loss patients?

Dr. Jacobs: Topical Janus kinase inhibitors (JAK inhibitors) are still in the early stages of testing, but some studies have shown they can be an effective combination, especially for those with severe alopecia areata. According to a study in the International Journal of Trichology, the two primary JAK inhibitors that have been tested have shown the most success with the regrowth of eyebrow and eyelash hairs, and it is believed by many that combining the JAK inhibitors with Rogaine can increase the effectiveness of each.1 For an additional treatment option that can be combined with Rogaine, some healthcare providers might recommend a treatment plan that combines Rogaine, which has the active ingredient minoxidil, with finasteride.

How do minoxidil and finasteride work synergistically?

Dr. Jacobs: Minoxidil and finasteride target different roots of hair growth. Finasteride blocks dihydrotestosterone (DHT) which can damage hair follicles, while minoxidil increases blood flow. A study in Dermatologic Therapy looked at the results of using minoxidil and finasteride together.2 After 12 months of treatment, 91.4% of the men who used finasteride and minoxidil at the same time showed improvements in hair growth, while only 80.5% and 59% of the men treated with finasteride or minoxidil alone saw improvements.

What about PRP?

Dr. Jacobs: A study in the International Journal of Trichology found that using platelet-rich plasma (PRP) in combination with minoxidil was more effective than using either treatment independently.3

What is possible today for hair loss patients that hasn’t been possible in the past?

Dr. Jacobs: There have been recent advancements in available treatments for alopecia areata patients. In 2022, the FDA approved baricitinib, (Olumiant, Eli Lilly, Inc.). In a study in the New England Journal of Medicine, nearly 40% of adults with alopecia areata taking Olumiant saw 80% scalp hair coverage after 1 year of treatment.4 The US Food and Drug Administration (FDA) approved Litfulo (ritlecitinib, Pfizer Inc) for severe alopecia areata in individuals 12 years of age and older in late June 2023. There are also more treatments for alopecia areata that are under FDA review. There have also been new developments recently showing that microRNA particles can be used to stimulate hair growth. The study, which appears in PNAS, claims that by softening stem cells, by boosting the production of a tiny RNA particle, they were able to relax the stiffness of the cells, and therefore stimulate hair growth.5

Dr. Jacobs has no relevant financial disclosures.

References can be found online at practicaldermatology.com

1. Malhotra K, Madke B. An updated review on current treatment of alopecia areata and newer therapeutic options. Int J Trichology. Epub 2023 Apr 19. 2023 Jan-Feb;15(1):3-12. doi: 10.4103/ijt.ijt_28_21. PMID: 37305188; PMCID: PMC10251289.

2. Hu R, Xu F, Sheng Y, et al. Combined treatment with oral finasteride and topical minoxidil in male androgenetic alopecia: a randomized and comparative study in Chinese patients. Dermatol Ther. Epub 2015 Jun 2. 2015 Sep-Oct;28(5):303-8. doi:10.1111/dth.12246. PMID: 26031764.

3. Elena EP, Irina OS. Combination therapy with platelet-rich plasma and minoxidil leads to better clinical results than monotherapy with these methods in men with androgenetic alopecia. Int J Trichology. Epub 2022 Feb 1. 2022 Jan-Feb;14(1):1-7. doi:10.4103/ijt.ijt_50_19. PMID: 35300100; PMCID: PMC8923145.

4. King B, Ohyama M, Kwon O, et al; BRAVE-AA Investigators. Two phase 3 trials of baricitinib for alopecia areata. N Engl J Med. Epub 2022 Mar 26. 2022 May 5;386(18):1687-1699. doi:10.1056/NEJMoa2110343. PMID: 35334197.

5. Wang J, Fu Y, Huang W, et al. MicroRNA-205 promotes hair regeneration by modulating mechanical properties of hair follicle stem cells. Proc Natl Acad Sci U S A. Epub 2023 May 22. 2023. May 30;120(22):e2220635120. doi:10.1073/pnas.2220635120. PMID: 37216502; PMCID: PMC10235966.