Hair & nails

Minoxidil well tolerated in treatment of paediatric alopecia areata


Although not approved for paediatric use, minoxidil appears to be safe and well tolerated when used off label to treat conditions such as alopecia areata in children, Victorian dermatologists have found.

With little data or guidance on the use of minoxidil in children, Dr Jared John and colleagues at Sinclair Dermatology, Melbourne, conducted a retrospective review of outcomes for 63 patients with an average age at initial consultation of ten years who were treated with low-dose oral minoxidil (LDOM) and sublingual minoxidil.

Most of the children (n= 42) were treated for alopecia areata/totalis, while others received minoxidil for loose anagen syndrome, female pattern hair loss, short anagen syndrome, trichotillomania, acute telogen effluvium, premature canities, congenital hypotrichosis, and kerion alopecia.

About a third of the children received minoxidil monotherapy, and others received concurrent medications including prednisolone, cyclosporine, azathioprine, tofacitinib, methotrexate, spironolactone, ketoconazole, terbinafine, and griseofulvin.

In his report, Dr John said sublingual minoxidil theoretically provides greater bioavailability than low dose oral minoxidil for the same dosage because it bypasses hepatic metabolism.19 However, since it is not readily available in Australia a suspension was  compounded by prescription.

In most children minoxidil was started at a dosage of 0.1 mg once daily, with dosages up-titrated according to treatment response to a maximum of 1.8 mg/day, or an average of 12.45 ng/kg body weight.

With a mean duration of treatment of 15 months and in some cases up to five years, there were no serious adverse effects reported with minoxidil.

The main side effects were facial/back hypertrichosis (n = 13), postural hypotension (n = 4) and headaches (n = 2), which were mild and did not lead to children stopping minoxidil  or having dose adjustment.

Other adverse events such as elevated liver enzymes, mood, and sleep disturbances, hypercholesterolemia, weight gain, and gastrointestinal symptoms, were attributed to concurrent prednisolone or tofacitinib.

“Common reasons for treatment discontinuation were perceived lack of or slow response to treatment, cost of recurring appointments and medications, patient or parent unavailability, and poor compliance,” the authors noted.

Writing in the International Journal of Dermatology (link) Dr John said the findings suggested that low dose oral minoxidil appeared to be a safe treatment for paediatric alopeacia areata, which could cause considerable distress and may lead to low self-esteem, depression, and social isolation in children.

“Future prospective studies that objectively measure the efficacy and optimum dose concentration of LDOM should be considered,” the authors concluded.

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