Clinical efficacy and safety of low‐dose oral minoxidil versus topical solution in the improvement of androgenetic alopecia: A randomized controlled trial

Abstract Background Topical minoxidil is the recommended first‐line pharmacologic treatment for male and female pattern hair loss. However, low‐dose oral minoxidil has been used off‐label with good clinical efficacy and safety. Aim To compare the effectiveness and safety of topical minoxidil as a first‐choice treatment of androgenetic alopecia versus 1 mg daily oral minoxidil. Method Sixty‐five AGA patients were randomly allocated to receive either 5% topical solution or 1 mg/day oral minoxidil for 6 months. Treatment efficacy was evaluated by measuring hair diameter, photographic assessment, and patient self‐assessment questionnaires. The safety of treatment was checked through history taking and physical examination. Results Both topical and oral minoxidil groups showed significant improvement in hair diameter after 6 months of treatment ( p < 0.001). However, there was no significant difference between the two groups. The photographic assessment demonstrated a significant improvement in hair density in the topical minoxidil group in all marked points located at 12 cm ( p = 0.025), 16 cm ( p = 0.034), and 24 cm ( p = 0.014) distance from the glabella but not in the oral minoxidil group. Nevertheless, the difference between the two groups was not significant. In each group, over 60% of patients expressed satisfaction with their treatments, and no significant difference was detected between the two groups. Conclusion Although topical minoxidil has a better overall therapeutic effect than 1 mg oral minoxidil, the difference between the two groups was not significant. Therefore, 1 mg oral minoxidil may be as effective and safe as standard topical minoxidil in female and male pattern hair loss.