Topical and oral minoxidil for hair disorders in pediatric patients: What do we know so far?

Abstract

Minoxidil is a strong arterial vasodilator, first introduced as an antihypertensive medication. In dermatology, topical minoxidil (TMX) has been used for many types of alopecia. TMX is not FDA-approved in patients under 18 years old and there are no guidelines for its pediatric use. Low-dose oral minoxidil (OMX) has been used offlabel for hair loss treatment in adults expecting to achieve better therapeutic compliance and greater clinical efficacy. However, little is known about TMX and OMX in pediatric population. the literature presented on TMX and OMX in children to date was reviewed. The terms "minoxidil", "child", "children", "childhood", and "infant" were used to perform a literature search in MEDLINE through PubMed. The search was limited to articles about humans and available in English. While 25 relevant articles were selected, duplicate titles were excluded. This article pointed out the use of minoxidil in several pediatric hair diseases. Even when used topically, dermatologists should be aware of potential risks of systemic absorption. In particular situations, OMX in very low doses may be considered. To date, there are no guidelines regarding the ideal dose or minimum age for using the drug topically or systemically.

Systemic Minoxidil Accidental Exposure in a Paediatric Population: A Case Series Study of Cutaneous and Systemic Side Effects

“…These data provide new information on the biological behaviour in the paediatric population of a well-established treatment for alopecia as minoxidil. The knowledge about the effects of minoxidil on children might be helpful to improve the use of minoxidil in paediatric patients with severe alopecic disorders, such as alopecia areata [ 4 ].…”

“…Regarding oral minoxidil and children the current scientific evidence is limited to a report of the accidental ingestion of minoxidil [ 14 ], a randomized clinical trial with 9 patients receiving oral minoxidil treatment for arterial wall hypertrophy for Williams–Beuren syndrome [ 15 ], and some case series about the use of oral minoxidil for refractory hypertension in children [ 16 , 17 , 18 ]. In addition, a recently published systematic review [ 4 ] addressed the issue of minoxidil and children, finding only reports of topical minoxidil in children and one report of low-dose oral minoxidil in a 11-years-old female. To the best of our knowledge, apart from a recent study, which addressed the treatment with low-dose oral minoxidil in children with loose anagen hair syndrome [ 19 ], there is a lack of evidence of the use of oral minoxidil in children.…”

Low‐dose oral minoxidil improves global hair density and length in children with loose anagen hair syndrome

“…In children, the side‐effects of topical minoxidil include contact dermatitis, transient hair shedding and generalized hypertrichosis 6 but the safety of LDOM in children has not been systematically evaluated. It was generally well tolerated in our patients, with hypertrichosis representing the only adverse effect.…”

“…The recommended starting dose of oral minoxidil for paediatric hypertension is 0·2 mg kg –1 daily (20 times the mean dose in our patients). However, oral minoxidil exerts minimal hypotensive effects in normotensive individuals 6 . A 2‐year‐old boy who accidentally ingested 100 mg of oral minoxidil in a single dose recovered fully after developing a transient reflex tachycardia 6 .…”

“…However, oral minoxidil exerts minimal hypotensive effects in normotensive individuals 6 . A 2‐year‐old boy who accidentally ingested 100 mg of oral minoxidil in a single dose recovered fully after developing a transient reflex tachycardia 6 . While the above observations are reassuring, close monitoring is essential and LDOM should be reserved for patients who are psychologically affected by the appearance of their hair, and/or fail to respond to topical minoxidil or do not improve spontaneously with age.…”