LOW-DOSE oral minoxidil (LDOM) has emerged as a promising off-label treatment for hair loss, with growing adoption among clinicians. An international expert panel of 43 dermatologists from 12 countries convened to establish consensus-based recommendations for LDOM use. This effort aimed to address the lack of robust, standardised guidelines and high-quality evidence.
The panel employed a modified Delphi process, refining recommendations over four survey rounds. Consensus was achieved on 76 items, encompassing diagnoses where LDOM may offer benefits, situations favouring oral over topical minoxidil, usage in adults and adolescents, and essential precautions. The group also agreed on baseline evaluations, monitoring protocols, adjunctive therapies, and indications for specialist referral. However, consensus was not reached for paediatric applications in children under 12 years or titration protocols for LDOM.
LDOM is considered particularly useful for patients unresponsive to topical minoxidil or those who experience adverse reactions to its topical form. The panel highlighted its potential for treating various hair loss conditions, such as androgenetic alopecia and telogen effluvium. Recommended precautions include thorough baseline assessments and vigilant monitoring for adverse effects like fluid retention or hypertrichosis. While adult dosing is better defined, adolescent use requires careful consideration, and paediatric applications remain underexplored due to limited data.
This expert consensus provides a foundation for clinicians to navigate LDOM prescribing until more comprehensive, evidence-based data are available. It highlights the need for future research, particularly in paediatric use, comparative efficacy against topical minoxidil, and long-term safety. Investigations into alternative off-label formulations, such as compounded or sublingual minoxidil, are also warranted.
As clinical practice evolves, these recommendations will require updates to reflect emerging evidence, ensuring that patients with hair loss receive safe and effective treatments. Until then, this consensus offers valuable guidance for incorporating LDOM into therapeutic strategies.
Katie Wright, EMJ
Reference
Akiska YM et al. Low-dose oral minoxidil initiation for patients with hair loss: an international modified delphi consensus statement. JAMA Dermatol. 2024;DOI:10.1001/jamadermatol.2024.4593.
