Article: Oral minoxidil shows benefit for lichen planopilaris

Key Points: 
- 51 patients with LPP used low dose oral minoxidil
- 92% patients showed stabilization or improvement
- Side effects were mild

Oral minoxidil continues to be a game changer for treating hair loss. When used appropriately, many patients benefit from its use. Practicing evidence-based medicine is a critical element of our approach at Pilaris. Moreover, finding improved treatments for difficult to treat conditions, such as scarring hair loss is important. For this reason, we were interested to find a recent report by a TricoHRS Research Group in Spain to document the efficacy of low dose oral minoxidil (LDOM) in lichen planopilaris (LPP), a form of cicatricial alopecia. 1–3 As we know, topical minoxidil can be problematic by the induction of itching due to a form of irritant dermatitis from one of the ingredients in the formulation and high rates of discontinuation. Therefore, LDOM is a well-tolerated and easy to use option. Vano-Galvan and his team reviewed records for LPP patients (clinically-diagnosed) who had been using LDOM for a period of at least 6 months, for a total of 51 patients (36 women and 15 men). Patients with concomitant frontal fibrosing alopecia (FFA) were excluded from the study. Most patients used around 1mg daily (range 0.25-2.5mg), with higher doses generally having higher chance of success. Standardized clinical images were reviewed by several expert dermatologists to assess whether scalp hair looked thicker and rated on a 3-point scale. In total, 92% of patients achieved either improvement (39%) or stabilization (53%). Side effects were infrequent but included excess hair (most common), lightheadedness when standing up (3 out of 51), rapid heartbeat (2 out of 51), and weight gain (1 out of 51), in line with previous reports. 4,5 It's also worth nothing that these patients were usually on additional LPP treatments during the study, so not all of the benefit may have come from minoxidil. Although the investigation was small and not randomized, these findings indicate that microdosed minoxidil is a viable and safe option for lichen planopilaris but the decision to use this medication should only be made with the assistance of your physician.

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1. Vano-Galvan, S. et al. Oral minoxidil improves background hair thickness in lichen planopilaris. J. Am. Acad. Dermatol. (2020) doi:10.1016/j.jaad.2020.04.026.

2. Bolduc, C., Sperling, L. C. & Shapiro, J. Primary cicatricial alopecia: Lymphocytic primary cicatricial alopecias, including chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and Graham-Little syndrome. J. Am. Acad. Dermatol. 75, 1081–1099 (2016).

3. Bolduc, C., Sperling, L. C. & Shapiro, J. Primary cicatricial alopecia. J. Am. Acad. Dermatol. 75, 1101–1117 (2016).

4. Vastarella, M. et al. Efficacy and safety of oral minoxidil in female androgenetic alopecia. Dermatol. Ther. e14234 (2020) doi:10.1111/dth.14234.

5. Jimenez-Cauhe, J. et al. Effectiveness and safety of low-dose oral minoxidil in male androgenetic alopecia. J. Am. Acad. Dermatol. 81, 648–649 (2019).