Can oral minoxidil be the game changer in androgenetic alopecia? A comprehensive review and meta-analysis comparing topical and oral minoxidil for treating androgenetic alopecia

Abstract Androgenetic alopecia (AGA) is a hair disorder seen in both sexes. Its aetiology is multifactorial. Treating AGA has always been a challenge for dermatologists. Only a few drugs such as topical minoxidil and finasteride are U.S. Food and Drug Administration-approved for treating AGA. Thus, looking for new and more effective treatment options for AGA is imperative. This review was conducted to compare the efficacy of oral with topical minoxidil in treating AGA. Only clinical trials that compared oral with topical minoxidil in treating AGA were included in this review. PubMed, Cochrane, Scopus and ClinicalTrials.gov were searched. A total of 2063 studies were retrieved from the databases. Four studies met the inclusion criteria and were included in this systematic review. Outcomes such as hair density, terminal hair density, hair count, global photographic assessment and negative hair pull were studied in this review. The results showed that there was no significant difference between oral and topical minoxidil in terms of improving the hair density of patients with AGA (overall mean difference 0.95, 95% confidence interval −24.98 to 26.87). Two studies showed that the mean difference in terminal hair density was greater in patients treated with oral minoxidil, but there was no significant difference between the two treatments in terms of improving terminal hair density. The efficacy of oral minoxidil is comparable to that of topical minoxidil in terms of improving hair density and terminal hair density in patients with AGA. Oral minoxidil can be used as an adjunct or as a second-line treatment option for AGA.