Dermnet Videos
Alopecia Videos
- Alopecia areata – Causes and Associated Conditions
- Alopecia Areata Information
- Alopecia Areata Treatment
- Course of Sudden Hair Loss Telogen Effluvium
- Evaluation and Treatment of Sudden Hairloss Telogen Effluvium
- Female Pattern Baldness and Hair Loss Causes
- Female Pattern Baldness and Hair Loss in Women
- Female Pattern Hair Loss Evaluation and Testing
- Female Pattern Hair Loss Treatment
- Hair loss and Alopecia Introduction
- Hair Loss Due To Hair Pulling – Trichotillomania
- Hair Loss Treatment and Male Pattern Baldness Medicine
- Loose Anagen Hair Syndrome
- Male Patern Baldness Causes and Hair Loss
- Male Pattern Baldness and Hair Loss Information
- Sudden Hair Loss Telogen Effluvium
- Traction Alopecia Hair Loss
- Traction Alopecia Hair Loss Treatment
- Central Centrifugal Cicatricial Alopecia
- Discoid Lupus Erythematosus – Clinical
- Discoid Lupus Erythematosus – Histology
- Discoid Lupus Erythematosus – Treatment
- Follicular Degeneration Syndrome
- Folliculitis Decalvans – Clinical
- Folliculitis Decalvans Treatment
- Hair Loss Alopecia With Scarring Information
- Lichen Planopilaris
- Lichen Planopilaris – Clinical Features
- Lichen Planopilaris Treatment
Video Topics
Female Pattern Hair Loss Treatment
The main side effects with 2 % minoxidil are scalp irritation and increased facial hair, both of which occur in about 5% of patients. True contact allergy to minoxidil is uncommon and occurs in <1% of patients. If irritation occurs, a trial of a preparation of propylene glycol (PG)-free minoxidil can be beneficial. This can be obtained from a compounding pharmacy. An initial six month trial of topical 2% minoxidil is given. If there has been no improvement in the patient’s hair loss (determined by measuring part widths or possibly photography), another 6 months of minoxidil therapy is given. A decision should be made as to whether to continue the 2% solution or increase to the 5% solution. Patients can definitely respond to the 2% solution during the second 6 months of therapy. However, some patients will request an increase to the stronger minoxidil.
There are some drawbacks to the stronger solution including worse irritation, an increased chance of irritation (about 10%) and an increased chance of developing facial hair (about 10%). The irritation is usually caused by increased amounts of propylene glycol in the 5% product and therefore 5% PG-free minoxidil is often needed. Additionally, there may be some absorption of the stronger minoxidil and therefore it should not be used in patients who are pregnant or nursing. The 5% minoxidil solution often feels greasy to women and therefore patients often use the 2% in the morning and the 5% in the evening. In my experience, approximately 60 to 70% of women with FPHL respond to minoxidil therapy.
Minoxidil is the only FDA-approved therapy for FPHL and the most beneficial. Other medical therapies have been tried, but have either not been well-studied or have not shown significant benefit in studies. These include finasteride, spironolactone, oral contraceptives, cyproterone acetate (not available in the United States) or flutamide. Hair transplantation plays a role in the treatment of significant FPHL.