Faculty Bibliography

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.

Direct-to-consumer (DTC) telehealth platforms have enhanced healthcare accessibility and convenience, particularly for Individuals in remote areas or those with mobility limitations. These platforms offer virtual medical consultations and prescription services, improving access to treatment for conditions such as hair loss, anxiety, depression, and sexual dysfunction. However, concerns regarding limited physician oversight, lack of transparency in provider qualifications, privacy risks, and potential financial and legal vulnerabilities highlight the need for stricter regulations. Addressing these issues is crucial to ensure patient protection and trust as the use of DTC telehealth services continues to grow.

IMPORTANCE/UNASSIGNED:The results of small studies suggest that off-label use of low-dose oral minoxidil (LDOM) may be safe and effective for patients with hair loss, but larger trials and standardized guidelines are lacking. OBJECTIVE/UNASSIGNED:To create an expert consensus statement for LDOM prescribing for patients with hair loss. EVIDENCE REVIEW/UNASSIGNED:The current literature on the pharmacological properties, adverse effect profile, and use of LDOM for patients with hair loss was reviewed. Topics of interest were identified, and a modified Delphi consensus process was created. A total of 43 hair loss specialist dermatologists from 12 countries participated in a modified Delphi process. Consensus was reached if at least 70% agreed or strongly agreed on a 5-point Likert scale. FINDINGS/UNASSIGNED:Over 4 survey rounds, 180 items in the first round, 121 items in the second round, 16 items in the third round, and 11 items in the fourth round were considered and revised. A total of 76 items achieved consensus including diagnoses for which LDOM may provide direct or supportive benefit, indications for LDOM compared to topical minoxidil, dosing for adults (18 years and older) and adolescents (aged 12 to 17 years), contraindications, precautions, baseline evaluation, monitoring, adjunctive therapy, and specialty consultation. Pediatric use and dosing items for children younger than 12 years, and LDOM titration protocols fell short of consensus. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This international expert consensus statement regarding the off-label prescribing of LDOM for patients with hair loss can help guide clinical practice until more data emerge. Hair loss experts with experience treating pediatric patients were underrepresented on this expert panel. Future research should investigate best practices for LDOM use in pediatric patients. Other critical topics for further investigation include the comparative efficacy of topical minoxidil vs oral minoxidil, the safety of oral minoxidil for patients with a history of allergic contact dermatitis to topical minoxidil, the long-term safety of LDOM, and the use of other off-label forms of minoxidil, such as compounded formulations of oral minoxidil and sublingual minoxidil. As additional evidence-based data emerge, these recommendations should be updated.