Low-Dose Oral Versus Topical Minoxidil in Androgenetic Alopecia

BACKGROUNDAndrogenetic alopecia (AGA) is a prevalent, progressive condition with significant psychosocial impact. Current pharmacological modalities like topical minoxidil and finasteride have limitations. Low-dose oral minoxidil has surfaced as a valid off-label solution, with the practical advantage of once-daily dosing.

OBJECTIVETo evaluate the efficacy and safety of topical and oral minoxidil in AGA.

METHODSIn this double-blind, double-dummy randomized controlled trial, 100 patients aged 18–50 years with AGA were randomized to receive either twice-daily topical minoxidil (5% in males, 2% in females) plus a placebo tablet, or once-daily oral minoxidil (2.5 mg in males, 1.25 mg in females) plus a placebo spray for 6 months. The primary outcome was the proportion of patients achieving ≥ +1 improvement in a validated 7-point global photographic scale. Secondary outcomes included patient satisfaction and adverse effects. Data were analyzed using SPSS v26 with p ≤ 0.05 as significant.

RESULTSNinety patients completed 24 weeks of follow-up. Photographic assessment demonstrated that mild-to-excellent improvement (≥ +1) occurred in both the oral (67%) and topical minoxidil (73%) groups (p = 0.652). Patient-reported satisfaction was high in both groups (topical: 70.5%; oral: 80.4%, p = 0.332), with a non-significant trend favoring oral minoxidil at the moderate satisfaction threshold (58.7% vs. 38.6%, p = 0.057). Median improvement scores were comparable between groups for both clinician assessment and patient-reported outcomes. Hypertrichosis was significantly more frequent with oral minoxidil (30% vs. 9%, p = 0.011), whereas contact dermatitis was exclusive to topical minoxidil (11% vs. 0%, p = 0.025). No serious adverse events were observed.

CONCLUSIONBoth topical and low-dose oral minoxidil demonstrated clinically meaningful improvement in androgenetic alopecia. Despite oral therapy exhibiting a trend toward higher patient satisfaction, this study was not powered to establish non-inferiority or equivalence. The dermatologist-assessed outcomes indicated no significant intergroup differences. Low-dose oral minoxidil may be considered a practical alternative in selected patients, particularly where adherence to topical therapy is limited.

TRIAL REGISTRATIONClinicalTrials.gov: NCT07273799

Abstract from Crossref