NYT HEALTH: An Old Medicine Grows New Hair for Pennies a Day, Doctors Say
By Gina Kolata
Section: Health
Source: New York Times
Published Date: August 18, 2022 at 03:00AM
By Gina Kolata
Section: Health
Source: New York Times
Published Date: August 18, 2022 at 03:00AM
Dermatologists who specialize in hair loss say that the key ingredient in a topical treatment worked even better when taken orally at a low dose.
The ads are everywhere — and so are the inflated claims: Special shampoos and treatments, sometimes costing thousands of dollars, will make hair grow. But many dermatologists who specialize in hair loss say that most of these products don’t work.“There is an endless array of useless hair growth remedies,” often at “significant cost,” said Dr. Brett King, a dermatologist at Yale School of Medicine. Yet, he added, “because people are desperate, such hair growth remedies continue to abound.”
But there is a cheap treatment, he and other dermatologists say, costing pennies a day, that restores hair in many patients. It is minoxidil, an old and well-known hair-loss treatment drug used in a very different way. Rather than being applied directly to the scalp, it is being prescribed in very low-dose pills.
Although a growing group of dermatologists is offering low-dose minoxidil pills, the treatment remains relatively unknown to most patients and many doctors. It has not been approved by the Food and Drug Administration for this purpose and so is prescribed off-label — a common practice in dermatology.
“I call us the off-label bandits — a title I am proud to bear,” said Dr. Adam Friedman, professor and chair of dermatology at George Washington University. He explained that dermatologists have been trained to understand how medicines work, which allows them to try drugs off-label. In dermatology, it is often clear if a treatment is helping. Does a rash fade, or not?
Dr. Robert Swerlick, professor and chair of the dermatology department at Emory University School of Medicine, agreed.
“I tell people most things we do are off-label because there is nothing on-label,” he said. He provided a long list of conditions, including skin pigment disorders, skin inflammatory disorders and relentless itching, for which the standard treatments are off-label.
Minoxidil, the active ingredient in Rogaine, a lotion or foam that is rubbed on the scalp, was first approved for men in 1988, then women in 1992, and it is now generic. The medicine’s use as a hair-growth treatment was discovered by accident decades ago. High-dose minoxidil pills were being used to treat high blood pressure, but patients often noticed that the pills prompted hair growth all over their bodies. So its manufacturer developed a minoxidil lotion — eventually named Rogaine — and got it approved to grow hair on balding heads.
But dermatologists say the lotion or foam is not particularly effective for some patients, perhaps because they stop taking it. It has to get on the scalp itself — and hair gets in the way. Many, especially women, stop using it because they dislike leaving the sticky substance in their hair.
Johnson and Johnson, the current owner of Rogaine, did not respond to requests for comment.
Others find it simply does not work for them. Minoxidil has to be converted to an active form by sulfotransferase enzymes that may or may not be present in sufficient quantities in hair roots. When the drug is taken orally, it is automatically converted to an active form.
But that was not the reason the low-dose pills were discovered. Instead, the discovery occurred also by accident 20 years ago.
Dr. Rodney Sinclair, a professor of dermatology at the University of Melbourne in Australia, had a patient with female pattern baldness. The hair on top of her head had thinned, and she hated the way it looked. Unlike what happened with most of his patients, Rogaine worked for her, but she developed an allergic rash on her scalp from the drug. Yet if she stopped taking it, her hair would thin again.
“So I was stuck,” Dr. Sinclair said. “The patient was very motivated, and the one thing we knew was that if a patient has an allergy to a topically applied medicine, one way to desensitize is to give very low doses orally.”
To do that, Dr. Sinclair tried cutting minoxidil pills into quarters. To his surprise, the low dose made her hair grow but did not affect her blood pressure, the original purpose of the higher-dose drug.
He subsequently lowered the dose more and more until he got down to effective doses of one-fortieth of a pill and began routinely prescribing the drug. That first patient still takes it.
At a meeting in Miami in 2015, Dr. Sinclair reported that low doses of minoxidil prompted hair growth in 100 successive women.
He published those results in 2017, noting that rigorous studies were needed, in which some patients would be randomly assigned to take minoxidil and others a sugar pill. But that has not happened. He says he has now treated more than 10,000 patients.
Recently, a rising number of hair-loss dermatologists have been giving the low-dose pills to patients with male and female pattern hair loss, a normal occurrence with age.
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Johnson and Johnson, the current owner of Rogaine, did not respond to requests for comment.
Others find it simply does not work for them. Minoxidil has to be converted to an active form by sulfotransferase enzymes that may or may not be present in sufficient quantities in hair roots. When the drug is taken orally, it is automatically converted to an active form.
But that was not the reason the low-dose pills were discovered. Instead, the discovery occurred also by accident 20 years ago.
Dr. Rodney Sinclair, a professor of dermatology at the University of Melbourne in Australia, had a patient with female pattern baldness. The hair on top of her head had thinned, and she hated the way it looked. Unlike what happened with most of his patients, Rogaine worked for her, but she developed an allergic rash on her scalp from the drug. Yet if she stopped taking it, her hair would thin again.
“So I was stuck,” Dr. Sinclair said. “The patient was very motivated, and the one thing we knew was that if a patient has an allergy to a topically applied medicine, one way to desensitize is to give very low doses orally.”
To do that, Dr. Sinclair tried cutting minoxidil pills into quarters. To his surprise, the low dose made her hair grow but did not affect her blood pressure, the original purpose of the higher-dose drug.
He subsequently lowered the dose more and more until he got down to effective doses of one-fortieth of a pill and began routinely prescribing the drug. That first patient still takes it.
At a meeting in Miami in 2015, Dr. Sinclair reported that low doses of minoxidil prompted hair growth in 100 successive women.
He published those results in 2017, noting that rigorous studies were needed, in which some patients would be randomly assigned to take minoxidil and others a sugar pill. But that has not happened. He says he has now treated more than 10,000 patients.
Recently, a rising number of hair-loss dermatologists have been giving the low-dose pills to patients with male and female pattern hair loss, a normal occurrence with age.
Read more: https://www.nytimes.com/2022/08/18/health/minoxidil-hair-loss-pills.html
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