Low-Dose Oral Minoxidil Initiation for Patients With Hair Loss: An International Modified Delphi Consensus Statement

Authors

Yagiz Matthew Akiska, George Washington University School of Medicine & Health Sciences, Washington, DC.
Paradi Mirmirani, Department of Dermatology, The Permanente Medical Group, Vallejo, California.
Ingrid Roseborough, Department of Dermatology, University of California, San Francisco.
Erin Mathes, Department of Dermatology, University of California, San Francisco.
Tina Bhutani, Department of Dermatology, University of California, San Francisco.
Andrew Ambrosy, Division of Research, Kaiser Permanente Northern California, San Francisco.
Crystal Aguh, Johns Hopkins School of Medicine, Baltimore, Maryland.
Wilma Bergfeld, Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, Ohio.
Valerie D. Callender, Callender Dermatology, Washington, DC.
Leslie Castelo-Soccio, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland.
George Cotsarelis, University of Pennsylvania, Philadelphia.
Brittany Gareth Craiglow, Yale School of Medicine, New Haven, Connecticut.
Nisha S. Desai, DermDX New England, Sonic Healthcare, Brighton, Massachusetts.
Isabella Doche, University of São Paulo Medical School, São Paulo, Brazil.
Bruna Duque-Estrada, Instituto de Dermatologia Prof Rubem David Azulay, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil.
Dirk M. Elston, Department of Dermatology, The Medical University of South Carolina, Charleston, South Carolina.
Carolyn Goh, University of California, Los Angeles.
Lynne J. Goldberg, DermDX New England, Sonic Healthcare, Brighton, Massachusetts.
Ramon Grimalt, Universitat Internacional de Catalunya, Barcelona, Spain.
Ali Jabbari, Department of Dermatology, University of Iowa, Iowa City, Iowa.
Victoria Jolliffe, Queen Mary University of London, London, United Kingdom.
Brett A. King, Yale School of Medicine, New Haven, Connecticut.
Charlotte LaSenna, University of Wisconsin-Madison.
Yolanda Lenzy, Lenzy Dermatology & Hair Loss Center, Chicopee, Massachusetts.
Jenna C. Lester, Department of Dermatology, University of California, San Francisco.
Nino Lortkipanidze, David Tvildiani Medical University, Tbilisi, Georgia.
Kristen I. Lo Sicco, The Ronald O Perelman Department of Dermatology, New York University Langone Health, New York.
Amy McMichael, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Nekma Meah, Mersey and West Lancashire NHS Trust, St Helens, United Kingdom.
Natasha Mesinkovska, University of California, Irvine.
Mariya Miteva, Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida.
Arash Mostaghimi, Department of Dermatology, Harvard Medical School, Brigham & Women's Hospital, Boston, Massachusetts.

Document Type

Journal Article

Publication Date

1-1-2025

Journal

JAMA dermatology

Volume

161

Issue

1

DOI

10.1001/jamadermatol.2024.4593

Abstract

IMPORTANCE: 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: To create an expert consensus statement for LDOM prescribing for patients with hair loss. EVIDENCE REVIEW: 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: 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: 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.

APA Citation

Akiska, Yagiz Matthew; Mirmirani, Paradi; Roseborough, Ingrid; Mathes, Erin; Bhutani, Tina; Ambrosy, Andrew; Aguh, Crystal; Bergfeld, Wilma; Callender, Valerie D.; Castelo-Soccio, Leslie; Cotsarelis, George; Craiglow, Brittany Gareth; Desai, Nisha S.; Doche, Isabella; Duque-Estrada, Bruna; Elston, Dirk M.; Goh, Carolyn; Goldberg, Lynne J.; Grimalt, Ramon; Jabbari, Ali; Jolliffe, Victoria; King, Brett A.; LaSenna, Charlotte; Lenzy, Yolanda; Lester, Jenna C.; Lortkipanidze, Nino; Lo Sicco, Kristen I.; McMichael, Amy; Meah, Nekma; Mesinkovska, Natasha; Miteva, Mariya; and Mostaghimi, Arash, "Low-Dose Oral Minoxidil Initiation for Patients With Hair Loss: An International Modified Delphi Consensus Statement" (2025). GW Authored Works. Paper 6470.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6470

Department

School of Medicine and Health Sciences Student Works