Health

Old pills grow new hair for coins every day, doctor says


The ads are everywhere – and so are the claims: Special shampoos and treatments, sometimes costing thousands of dollars, will make hair grow. But many dermatologists who specialize in hair loss say most of these products don’t work.

“There are a multitude of useless hair growth remedies,” says Dr. Brett King, a dermatologist at Yale School of Medicine. However, he added, “because people are desperate, such hair growth remedies continue to abound.”

But there is an inexpensive treatment that, according to him and other dermatologists, costs a few cents a day, can restore hair in many patients. That’s minoxidil, an old and well-known hair loss medication used in a very different way. Instead of being applied directly to the scalp, it is prescribed as a very low dose pill.

Although more and more dermatologists are offering low-dose minoxidil oral, most patients and many doctors still don’t know the treatment. It has not been approved by the Food and Drug Administration for this purpose and is therefore prescribed off-label – a common practice in dermatology.

Dr Adam Friedman, professor and chair of dermatology at George Washington University, said: “I call us off-label bandits – a title I proudly carry. He explains that dermatologists have been trained to understand how drugs work, which allows them to try off-label medications. In dermatology, it is often clear whether a treatment is effective or not. Does the rash fade or not?

Dr. Robert Swerlick, professor and chair of dermatology at Emory University School of Medicine, agrees.

“I tell people that most of the things we do are unbranded because there is nothing on the label,” he said. He provided a long list of conditions, including dyspigmentation, inflammatory skin disorders, and incessant itching, for which standard treatments were off-label.

Minoxidil, the active ingredient in Rogaine, a lotion or foam applied to the scalp, was first approved for men in 1988, then for women in 1992, and now it is a generic drug. . The use of the drug as a treatment for hair growth was discovered by accident decades ago. High-dose minoxidil is being used to treat high blood pressure, but patients often notice that the drug stimulates hair growth all over their body. So its maker developed a minoxidil lotion – eventually named Rogaine – and it was approved to grow hair on bald heads.

But dermatologists say lotions or foams aren’t particularly effective for some patients, perhaps because they stop using them. It has to work on its own on the scalp – and the hair will stay in place. Many people, especially women, stop using it because they don’t like leaving a sticky residue in their hair.

Johnson and Johnson, the current owners of Rogaine, did not respond to a request for comment.

Others find it simply doesn’t work for them. Minoxidil must be converted to the active form by sulfotransferase enzymes which may or may not be present in sufficient quantities in the hair roots. When the drug is taken orally, it is automatically converted to the active form.

But that’s not why the low-dose pills were discovered. Instead, this discovery also happened by chance 20 years ago.

Dr Rodney Sinclair, professor of dermatology at the University of Melbourne in Australia, had a patient with female pattern baldness. The hair on her head was thinning, and she hated that look. Unlike what happened to most of her patients, Rogaine worked for her, but she developed an allergic rash on her scalp due to the medication. However, if she stops taking it, her hair will thin again.

“So I was stuck,” Dr. Sinclair said. “Patients are very motivated, and one thing we know is that if a patient is allergic to a topical medication, one way to desensitize is to take it orally at a very low dose.”

To do that, Dr. Sinclair tried cutting the minoxidil pill into quarters. To his surprise, the low dose made her hair grow but had no effect on her blood pressure, the original purpose of the higher dose.

After that, he reduced the dosage more and more until he was reduced to the effective dose of one forty-fourth of a pill and began to prescribe it on a regular basis. The first patient is still drinking.

At a meeting in Miami in 2015, Dr. Sinclair reported that small doses of minoxidil promoted hair growth in 100 consecutive 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 to take a sugar pill. But that did not happen. He said he has now treated more than 10,000 patients.

Recently, a growing number of hair loss dermatologists have been giving low-dose medication to patients with male and female pattern hair loss, which is a normal occurrence with age.

Dr Crystal Aguh said: “People are just starting to see an increase in popularity. a dermatologist at the Johns Hopkins School of Medicine. “More and more at conferences, we are sharing our success stories.”

Doctors who don’t specialize in hair loss, she adds, “will not be familiar with the oral drug minoxidil, except for a rarely used high blood pressure treatment that comes with a black box warning that it can cause heart problems. However, she and others say, the warning is for much higher doses.

Dr. Aguh warns: If the hair loss is too severe, minoxidil won’t help. “It won’t work, for example, if a man is mostly bald, with a shiny scalp. There is nothing to restore”. She adds that the ideal patient is not completely bald but has lost enough hair that even a casual observer would notice.

However, without a rigorous test that leads to FDA approval, the use of minoxidil pills for hair loss remains off-label. And, dermatologists say, it’s likely to stay that way.

“The oral minoxidil costs a few cents a day,” says Dr. King. “There is no incentive to spend tens of millions of dollars to test it in a clinical trial. That research really is never, never will be done. “

However, some patients taking low doses of minoxidil notice hair growth on their face and chin. So some dermatologists, including Dr. Sinclair, have added another drug – a very low dose of spironolactone, a blood pressure drug that also blocks certain sex hormones called androgens – to try Try to prevent unwanted hair growth.

Patients who don’t want to go the off-label route may consider what some dermatologists say useless over-the-counter medication or one of two FDA-approved products for hair growth.

These include Rogaine and Finasteride, a common medication used in higher doses in men to treat benign prostatic hyperplasia. As an anti-hair loss drug, it is only allowed for use by men. It has also been linked to sexual dysfunction.

Then there was word of mouth about minoxidil in pill form.

“I have seen miracles happen,” Dr. Aguh said.

One involves Brandy Grey, 44, who lives in Monkton, Md.

“I have had hair loss from time to time,” she says. “After that, I started to have round patches” of hairless hair. “They just got worse and worse.”

She saw another dermatologist, who gave her shampoo and supplements, but to no avail. In the end, she says her dermatologist told her, “I have nothing more to try for you, there’s nothing more I can do.”

She went to see Dr. Aguh, who gave her a low dose of minoxidil. Ten months later, her hair is thick and abundant.

“I can part my hair in different ways,” she says. “I don’t wear a wig anymore.”

It’s as if hair loss never happened.



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