Androgenetic Alopecia (AGA)
The only people who are allowed to self-treat for AGA
People with a family history of hair loss
Wigs, hair weaves, scalp massage, hair volumizing approaches, frequent hair washing, electrical scalp stimulaton, dietary supplements, scalp camoflauge, low-level light therapy
Wigs, Hair Weaves, Hair volumizing approaches, scalp camoflauge, low-level light therapy
What do you do NOT do if you miss a dose of Minoxidil solution?
Do NOT double the dose
What is the MOA of Minoxidil?
Opens K+ channels and causes vasodilation to increase scalp blood flow to hair follicles, reduces inflammation, causes follicular hypertrophy to result in thickened hair shafts, prolongs anagen phase and shortens telogen phase
A 24-year-old man with gradual thinning at the crown asks for an OTC product to regrow hair. He denies medical problems and takes no medications. Which of the following is the most appropriate recommendation?
A. Avoid self-treatment because he is under 26 years old
B. Recommend 5% topical minoxidil
C. Recommend scalp massage
D. Recommend B-vitamin supplements
B
Rationale: Adult male with AGA → 5% solution or foam preferred; massage and vitamins are ineffective.
True or False? In AGA, the anagen phase is decreased, and the catagen and telogen phases are increased, resulting in a shorter growing phase, decreased # of hairs, and increased shedding
True
What is the OTC option for AGA?
Minoxidil 2% and 5% solution, 5% foam
Describe application methods of Minoxidil solution
Apply to clean, dry scalp and hair.
Rub about 1 mL of the product into the affected area. Maximum 2x/day
Allow 2-4 hours for the drug to penetrate the scalp and do not participate in bathing or swimming without a cap for 2-4 hours after application
At night, apply 2-4 hours before bedtime
A hair dryer on low setting may be used after applying to speed dry
What is the appropriate follow-up time?
4 months
A 32-year-old woman presents with new-onset diffuse hair thinning 3 months after delivering her baby. She wants to try minoxidil. Which is the best recommendation?
A. Start 2% minoxidil solution
B. Start 5% minoxidil foam
C. Do not self-treat; refer to a medical provider
D. Recommend low-level light therapy only
C
Rationale: Postpartum hair loss is listed as an exclusion for self-care.
Describe male etiology of AGA
Increased testosterone--> increased 5-alpha reductase activity--> DHT (represses hair growth)--> AGA
Which Minoxidil formulations are approved for women?
2% solution and 5% foam
True or False? Avoid using topical minoxidil on the day of and for 24 hours after using perjmanent wave or hair color product to reduce scalp irritation
True
What are the phases of hair growth and how are they affected by AGA?
Anagen: Decreased with AGA
Catagen: Increased with AGA resulting in more dead hair
Telogen: Increased with AGA resulting in more shedding
Exogen: Release of dead hair
A 48-year-old woman has patchy hair loss that began suddenly two weeks ago. Examination reveals scaling on the scalp and broken hairs. She wants an OTC option. What is the most appropriate action?
A. Recommend 2% minoxidil
B. Recommend 5% foam
C. Recommend hair fibers to camouflage the area
D. Refer to a medical provider immediately
D
Rationale: Sudden/patchy loss, scalp scaling, broken hairs → exclusions for self-care (possible autoimmune, infection, or tinea).
Differentiate between MPHL and FPHL
MPHL: Begins at top of head and creates U-shaped around sides
FPHL: Gradual thinning over crown and mid-frontal scalp, hairs are thinner and shorter
Which Minoxidil formulations are approved for men? Which ones are preferred?
2% solution, 5% solution, 5% foam--> the FIVES are preferred
Describe the applications methods for Minoxidil foam
The foam may melt on contact with warm skin so wash hands in cold water and dry them before applying foam
Within the thinning hair area, part the hair into one or more rows to maximize contact of the foam with the scalp. The hair the should be completely dry before application
Apply 1/2 capful of foam 2x/day
The 5% product for women should be applied only 1x/day
What is the solvent for 2% and 5% Minoxidil solution?
Hydroalcoholic/propylene glycol vehicle
A 40-year-old man with male-pattern baldness started 5% minoxidil solution 1 week ago. He returns worried about increased shedding. What is the most appropriate counseling point?
A. Discontinue therapy because this indicates intolerance
B. This is expected; continue therapy for at least 4 months
C. Reduce dose to once daily
D. Switch to vitamins and scalp massage
B
Rationale: Early increased shedding occurs in first weeks due to follicles shifting from telogen → anagen.
List as many exclusions for self-care for AGA as possible
1. <18 years old
2. Pregancy/Lactation
3. Postpartum
4. NO FAMILY HISTORY of hair loss
5. Endocrine dysfunction
6. Medications
7. Dietary deficiencies
8. Sudden or patchy hair loss
9. Fever or inflammation 3-6 months before hair loss
10. Skin lesions associated with autoimmune process
11. Scaling, sunburn, or other scalp damage
12. Broken Hairs
13. Loss of eyebrows or eyelashes
14. Pitting of nails or other abnormalities
15. Weight loss
Differentiate between the dosing for the solutions and foam formulations of Minoxidil
Solutions: 1 mL BID
Foams: 1/2 capful BID
What are the three drug interactions with Minoxidil? When should you avoid use?
Topical Corticosteroids, Petrolatum, Retinoids
Avoid: if preexisting CV conditions
What is the solvent for 5% Minoxidil Foam?
Solvent-Free
A 56-year-old man with a history of uncontrolled hypertension and significant sunburn on the scalp is seeking OTC treatment for hair loss. His only medication is a topical corticosteroid for psoriasis. Which of the following is the BEST recommendation?
A. Start 5% minoxidil foam twice daily
B. Start 2% minoxidil solution because it has fewer side effects
C. Avoid self-treatment with minoxidil and refer for further evaluation
D. Start minoxidil but apply immediately after the corticosteroid for increased penetration
C
Rationale: Exclusions/precautions → scalp damage (severe sunburn), cardiovascular disease risk with vasodilation, and interaction with topical corticosteroids.