The following is a summary of “Oral Minoxidil vs Topical Minoxidil for Male Androgenetic Alopecia: A Randomized Clinical Trial,” published in the April 2024 issue of Dermatology by Penha, et al.

There was growing interest in using low-dose oral minoxidil for treating androgenetic alopecia (AGA). However, compared to topical minoxidil for male AGA, its efficacy remained unexplored in comparative therapeutic trials. For a study, researchers sought to compare the efficacy, safety, and tolerability of daily oral minoxidil (5 mg) versus twice-daily topical minoxidil (5%) over 24 weeks in treating male AGA.

The double-blind, placebo-controlled, randomized clinical trial was conducted at a specialized clinic in Brazil. Men aged 18 to 55 years with AGA, classified as Norwood-Hamilton scale 3V, 4V, or 5V, were included. Data were collected from January to December 2021, with analysis conducted from September 2022 to February 2023. Participants were randomly assigned 1:1 to either oral minoxidil (5 mg daily) with topical placebo solution or topical minoxidil (5% solution, 1 mL twice daily) with oral placebo for 24 weeks. The primary outcome was a change in terminal hair density on the frontal and vertex scalp regions. Secondary outcomes included a change in total hair density and photographic evaluations.

Of the 90 enrolled participants, 68 completed the study, and the mean (SD) age was 36.6 (7.8) years. Both treatment groups (33 in oral minoxidil, 35 in topical minoxidil) were similar in demographics and AGA severity. At week 24, there were no significant differences between groups in change in terminal hair density in the frontal (P = .27) or vertex (P = .09) regions, nor in total hair density (frontal P = .32; vertex P = .32). Photographic analysis indicated oral minoxidil was superior on the vertex (24%; P = .04) but not on the frontal scalp (12%; P = .24). Common adverse effects with oral minoxidil included hypertrichosis (49%) and headache (14%).

Oral minoxidil (5 mg daily for 24 weeks) did not demonstrate superior efficacy over twice-daily topical minoxidil (5%) in men with AGA. The study underscored the need for further research to determine optimal treatment strategies for male AGA, considering both efficacy and safety profiles.

Reference: jamanetwork.com/journals/jamadermatology/article-abstract/2817326