Faculty Bibliography

Minoxidil has become an increasingly popular treatment option for hair loss disorders including androgenetic alopecia, cicatricial alopecia, and alopecia areata. There are various minoxidil formulations available including topical, oral, and injectable minoxidil. While injectable minoxidil may offer certain advantages, potential risks and costs should also be considered. First, we explore the enhanced bioavailability of injectable minoxidil in comparison to topical and oral formulations, as well as the variability in sulfotransferase enzyme levels and its role in the activation of minoxidil at hair follicles. Furthermore, we expand upon the potential adverse effects associated with injectable minoxidil given its widespread systemic distribution. We also highlight the importance of considering cost, access, and availability of injectable minoxidil given that injections are significantly more expensive than oral minoxidil tablets and involve the additional obstacle of frequent dermatology visits. Depending on geographic region and socioeconomic status, many patients may not live in sufficiently close proximity to a dermatologist for this level of care. Finally, we emphasize the need for ongoing research efforts to compare the efficacy, access, and tolerability of injectable minoxidil, alternative minoxidil formulations, and other alopecia medications.

Low-dose oral minoxidil (LDOM) has emerged as a widely used off-label treatment for different types of alopecia, showing a favorable safety profile and effectiveness. Despite its growing use, it is essential to understand the possible associated adverse events (AEs) and their appropriate management to optimize this therapy. The aim of this article was to comprehensively review the AEs of LDOM treatment, describing their frequency, risk factors, affected anatomical sites, and management strategies. A search in the PubMed and EMBASE databases was performed for studies published before 31 December 2024, reporting the treatment of any type of hair loss with oral minoxidil. The most frequent AE is hypertrichosis, occurring in approximately 15% of patients, with a higher incidence in women and patients with higher doses. Fluid retention affects 1.3-10% of patients, particularly women, and typically occurs within 1-3 months of treatment. Other cardiovascular AEs, such as tachycardia or dizziness, occur in fewer than 5% of cases and are usually mild and transient. Severe AEs, including pericardial effusion, are extremely rare and often linked to compounding errors comprising an excessive dose. Management strategies include dose reduction, pharmacological interventions like diuretics for edema, and lifestyle measures such as sodium restriction. In most cases, AEs resolve without the need for treatment discontinuation. The favorable safety profile of LDOM makes it a valuable therapeutic option for alopecia, though careful patient selection, dose titration, and monitoring are essential to minimize risks.

Cutaneous lupus erythematosus (CLE) is an autoimmune disease with diverse clinical manifestations, including patchy hair loss resembling alopecia areata (AA). This report describes two cases of CLE presenting as AA mimickers, emphasizing the need to consider CLE in differential diagnosis for patchy hair loss. Early and accurate diagnosis is crucial for effective management and preventing scarring alopecia. J Drugs Dermatol. 2025;24(3):324-326. doi:10.36849/JDD.7793R1.

BACKGROUND:Baricitinib, an oral selective Janus kinase inhibitor, is approved to treat adults with severe alopecia areata (AA). OBJECTIVE:To report the Week 152 efficacy results from the Phase 3 trial BRAVE-AA2 down-titration sub-study. METHODS:BRAVE-AA2 enrolled 546 adults with severe AA (Severity of Alopecia Tool [SALT] score ≥50). Baricitinib 4-mg treated patients achieving a clinical response (SALT score ≤20) at Week 52 were rerandomized 1:1 to stay on 4-mg or down-titrate to 2-mg. Last observation carried forward was used to impute missing or censored data. RESULTS:At Week 52, 86/234 (36.8%) baricitinib 4-mg treated patients were eligible for down-titration; 44 remained on 4-mg while 42 down-titrated to 2-mg. At Week 152, 39/44 (88.6%) 4-mg treated patients had maintained clinical response, compared to 24/41 (58.5%) down-titrated patients. Among down-titrated patients, loss of treatment benefit was less frequent in those with sustained response and SALT score ≤5 at Week 52. LIMITATIONS/CONCLUSIONS:Method and timing of down-titration were pre-specified in the protocol based on Week 52 responder status and not on other clinical factors. CONCLUSION/CONCLUSIONS:More than half of down-titrated patients maintained response. Sustained treatment response and/or near-total regrowth may be associated with a greater likelihood of response maintenance after down-titration.