Low-Dose Oral Minoxidil Initiation for Patients With Hair Loss: An International Modified Delphi Consensus Statement
Issued Date
2025-01-01
Resource Type
eISSN
21686084
Scopus ID
2-s2.0-85215872881
Pubmed ID
39565602
Journal Title
JAMA dermatology
Volume
161
Issue
1
Start Page
87
End Page
95
Rights Holder(s)
SCOPUS
Bibliographic Citation
JAMA dermatology Vol.161 No.1 (2025) , 87-95
Suggested Citation
Akiska Y.M., Mirmirani P., Roseborough I., Mathes E., Bhutani T., Ambrosy A., Aguh C., Bergfeld W., Callender V.D., Castelo-Soccio L., Cotsarelis G., Craiglow B.G., Desai N.S., Doche I., Duque-Estrada B., Elston D.M., Goh C., Goldberg L.J., Grimalt R., Jabbari A., Jolliffe V., King B.A., LaSenna C., Lenzy Y., Lester J.C., Lortkipanidze N., Lo Sicco K.I., McMichael A., Meah N., Mesinkovska N., Miteva M., Mostaghimi A., Ovcharenko Y., Piliang M., Piraccini B.M., Rakowska A., Salkey K.S., Schmidt A., Shapiro J., Sibbald C., Sinclair R., Suchonwanit P., Taylor S., Tosti A., Vañó-Galván S., Wall D.R., Fu J.M. Low-Dose Oral Minoxidil Initiation for Patients With Hair Loss: An International Modified Delphi Consensus Statement. JAMA dermatology Vol.161 No.1 (2025) , 87-95. 95. doi:10.1001/jamadermatol.2024.4593 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/103109
Title
Low-Dose Oral Minoxidil Initiation for Patients With Hair Loss: An International Modified Delphi Consensus Statement
Author(s)
Akiska Y.M.
Mirmirani P.
Roseborough I.
Mathes E.
Bhutani T.
Ambrosy A.
Aguh C.
Bergfeld W.
Callender V.D.
Castelo-Soccio L.
Cotsarelis G.
Craiglow B.G.
Desai N.S.
Doche I.
Duque-Estrada B.
Elston D.M.
Goh C.
Goldberg L.J.
Grimalt R.
Jabbari A.
Jolliffe V.
King B.A.
LaSenna C.
Lenzy Y.
Lester J.C.
Lortkipanidze N.
Lo Sicco K.I.
McMichael A.
Meah N.
Mesinkovska N.
Miteva M.
Mostaghimi A.
Ovcharenko Y.
Piliang M.
Piraccini B.M.
Rakowska A.
Salkey K.S.
Schmidt A.
Shapiro J.
Sibbald C.
Sinclair R.
Suchonwanit P.
Taylor S.
Tosti A.
Vañó-Galván S.
Wall D.R.
Fu J.M.
Mirmirani P.
Roseborough I.
Mathes E.
Bhutani T.
Ambrosy A.
Aguh C.
Bergfeld W.
Callender V.D.
Castelo-Soccio L.
Cotsarelis G.
Craiglow B.G.
Desai N.S.
Doche I.
Duque-Estrada B.
Elston D.M.
Goh C.
Goldberg L.J.
Grimalt R.
Jabbari A.
Jolliffe V.
King B.A.
LaSenna C.
Lenzy Y.
Lester J.C.
Lortkipanidze N.
Lo Sicco K.I.
McMichael A.
Meah N.
Mesinkovska N.
Miteva M.
Mostaghimi A.
Ovcharenko Y.
Piliang M.
Piraccini B.M.
Rakowska A.
Salkey K.S.
Schmidt A.
Shapiro J.
Sibbald C.
Sinclair R.
Suchonwanit P.
Taylor S.
Tosti A.
Vañó-Galván S.
Wall D.R.
Fu J.M.
Author's Affiliation
David Tvildiani Medical University
Ramathibodi Hospital
Faculty of Biology, Medicine and Health
Iowa City VA Health Care System
Santa Casa da Misericórdia do Rio de Janeiro
Medical University of Warsaw
Universitat Internacional de Catalunya
Permanente Medical Group
University of Wisconsin-Madison
UCSF School of Medicine
Wake Forest University School of Medicine
The Hospital for Sick Children
University of Miami
Alma Mater Studiorum Università di Bologna
Universidad de Alcalá
University of California, Los Angeles
V. N. Karazin Kharkiv National University
University of Melbourne
The George Washington University School of Medicine and Health Sciences
NYU Grossman School of Medicine
Queen Mary University of London
University of Miami Leonard M. Miller School of Medicine
Cleveland Clinic Foundation
Mater Misericordiae University Hospital
Yale School of Medicine
Kaiser Permanente
Brigham and Women's Hospital
University of Iowa Carver College of Medicine
Howard University College of Medicine
Universidade de São Paulo
University of California, Irvine
Boston University Chobanian & Avedisian School of Medicine
University of Pennsylvania
College of Medicine
University College Dublin
University of Pennsylvania Perelman School of Medicine
Virginia Commonwealth University
Johns Hopkins University School of Medicine
UConn Health
Callender Dermatology
Sonic Healthcare
Callendar Cosmetic Center
Mersey and West Lancashire NHS Trust
Sinclair Dermatology
National Institute of Arthritis and Musculoskeletal and Skin Diseases
National and International Skin Registry Solutions (NISR)
Kaiser Permanente Northern California
Lenzy Dermatology & Hair Loss Center
Santa Monica Dermatology Medical Group
Dermatology Unit
Solano Dermatology Associates
Ramathibodi Hospital
Faculty of Biology, Medicine and Health
Iowa City VA Health Care System
Santa Casa da Misericórdia do Rio de Janeiro
Medical University of Warsaw
Universitat Internacional de Catalunya
Permanente Medical Group
University of Wisconsin-Madison
UCSF School of Medicine
Wake Forest University School of Medicine
The Hospital for Sick Children
University of Miami
Alma Mater Studiorum Università di Bologna
Universidad de Alcalá
University of California, Los Angeles
V. N. Karazin Kharkiv National University
University of Melbourne
The George Washington University School of Medicine and Health Sciences
NYU Grossman School of Medicine
Queen Mary University of London
University of Miami Leonard M. Miller School of Medicine
Cleveland Clinic Foundation
Mater Misericordiae University Hospital
Yale School of Medicine
Kaiser Permanente
Brigham and Women's Hospital
University of Iowa Carver College of Medicine
Howard University College of Medicine
Universidade de São Paulo
University of California, Irvine
Boston University Chobanian & Avedisian School of Medicine
University of Pennsylvania
College of Medicine
University College Dublin
University of Pennsylvania Perelman School of Medicine
Virginia Commonwealth University
Johns Hopkins University School of Medicine
UConn Health
Callender Dermatology
Sonic Healthcare
Callendar Cosmetic Center
Mersey and West Lancashire NHS Trust
Sinclair Dermatology
National Institute of Arthritis and Musculoskeletal and Skin Diseases
National and International Skin Registry Solutions (NISR)
Kaiser Permanente Northern California
Lenzy Dermatology & Hair Loss Center
Santa Monica Dermatology Medical Group
Dermatology Unit
Solano Dermatology Associates
Corresponding Author(s)
Other Contributor(s)
Abstract
Importance: The results of small studies suggest that off-label use of low-dose oral minoxidil (LDOM) may be safe and effective for patients with hair loss, but larger trials and standardized guidelines are lacking. Objective: To create an expert consensus statement for LDOM prescribing for patients with hair loss. Evidence Review: The current literature on the pharmacological properties, adverse effect profile, and use of LDOM for patients with hair loss was reviewed. Topics of interest were identified, and a modified Delphi consensus process was created. A total of 43 hair loss specialist dermatologists from 12 countries participated in a modified Delphi process. Consensus was reached if at least 70% agreed or strongly agreed on a 5-point Likert scale. Findings: Over 4 survey rounds, 180 items in the first round, 121 items in the second round, 16 items in the third round, and 11 items in the fourth round were considered and revised. A total of 76 items achieved consensus including diagnoses for which LDOM may provide direct or supportive benefit, indications for LDOM compared to topical minoxidil, dosing for adults (18 years and older) and adolescents (aged 12 to 17 years), contraindications, precautions, baseline evaluation, monitoring, adjunctive therapy, and specialty consultation. Pediatric use and dosing items for children younger than 12 years, and LDOM titration protocols fell short of consensus. Conclusions and Relevance: This international expert consensus statement regarding the off-label prescribing of LDOM for patients with hair loss can help guide clinical practice until more data emerge. Hair loss experts with experience treating pediatric patients were underrepresented on this expert panel. Future research should investigate best practices for LDOM use in pediatric patients. Other critical topics for further investigation include the comparative efficacy of topical minoxidil vs oral minoxidil, the safety of oral minoxidil for patients with a history of allergic contact dermatitis to topical minoxidil, the long-term safety of LDOM, and the use of other off-label forms of minoxidil, such as compounded formulations of oral minoxidil and sublingual minoxidil. As additional evidence-based data emerge, these recommendations should be updated.