Every day, thousands of people seek methods to treat hair loss. About one third of the men and one sixth of the women in the United States have some degree of androgenetic alopecia (hereditary hair loss), which is a progressive, patterned loss of hair from the scalp and the most prevalent type of hair loss.1 Currently, androgenetic alopecia is the only type of hair loss that is effectively treated with the use of OTC hair-loss products.1 Hair loss may also be secondary to acute or chronic illness, use of certain medications, trauma, dietary changes, endocrine disorders, or hormonal changes.1
Men with androgenetic alopecia may experience hair loss that often begins at the temples and crown. Some men may go through partial or complete baldness. Women experiencing androgenetic alopecia typically have thinning of the hair at the front of the hairline, as well as the sides or crown.1
The only FDA-approved OTC products currently available for the treatment of hair loss are minoxidil 2% and extra-strength minoxidil 5% as hydroalcoholic topical solutions.1 Although it is not well-proven, however, some individuals with other types of hair loss such as alopecia areata (sometimes called "spot baldness") have reported some success with the use of these products.1 Patients with sudden hair loss or nonpattern hair loss should always be encouraged to seek medical advice before using minoxidil products. Topical minoxidil 2% can be used by both men and women, but the use of topical minoxidil 5% is contraindicated in women due to an increased risk of facial hair growth.1 Minoxidil exerts its therapeutic effect by increasing cutaneous blood flow directly to hair follicles, which, in turn, increase in size after treatment. There are no known drug interactions associated with the use of topical minoxidil, and since minoxidil is absorbed through the skin in low concentrations, the incidence of systemic adverse effects are rare. The most common adverse effects associated with the long-term use of topical minoxidil are transient hypertrichosis and local itching or irritation.1 Minoxidil should only be used only in patients 18 years of age and older.
Prior to recommending the use of topical minoxidil products, it is important to ascertain if self-treatment is appropriate and to identify the cause of the hair loss. Patients should always be referred to their primary care physician for further evaluation if the cause of hair loss is unknown or sudden. It is important for women who experience hair loss to be evaluated by their primary care physician to determine possible causes or contributing factors.1 Alopecia is often seen in women with polycystic ovarian syndrome. Examples of exclusions for self-treatment include the following1:
Pharmacists can assist patients experiencing hair loss by reviewing medication profiles and possibly identifying those pharmacologic agents that may be associated with an increased risk of hair loss. Pharmacists should ensure that patients using minoxidil products are properly counseled on their correct use, as well as the importance of adhering to continuous use of the product to maintain regrowth of hair.1,2 In addition, pharmacists should inform patients that the product may not be effective for everyone and that it is a suppressive therapy and not a cure.1,2 Patients should also be informed that if there is no sign of new hair growth after 4 to 6 months of therapy, use of the product should be discontinued, and consultation with the primary health care provider is recommended.1
1. Hogue M. Hair loss. Berardi RR, Kroon LA, McDermott J, et al, eds. Handbook of Nonprescription Drugs. 15th ed. Washington, DC: American Pharmacists Association; 2006: 941-951.