BH04 Growing interest: a survey of low-dose oral minoxidil prescribing for hair loss

Abstract Low-dose oral minoxidil (LDOM) has been increasingly used as an off-label treatment for patients with hair loss. We aimed to assess indications for LDOM prescribing and monitoring practices among dermatologists in the UK and Ireland. An anonymous survey was sent to members of the British Hair and Nail Society (BHNS) and the Irish Association of Dermatologists (IAD). Data regarding indications for LDOM prescribing, dose titration and monitoring practices was collected. In total, 29 responses were collected. Seventeen respondents (59%) were BHNS members and 79% (n = 23) were consultant dermatologists, with 38% (n = 11) having specialist hair clinics. Twelve (41%) see over 20 patients with hair loss per month and 12 (41%) see five to 20 patients per month. Eight (28%) prescribe LDOM multiple times per week and seven (24%) at least once a week. Most (96%, 25 of 26) would prescribe LDOM for androgenic alopecia, 65% (17 of 26) for frontal fibrosing alopecia/lichen planopilaris (FFA/LPP), 62% (16 of 26) for alopecia areata and 50% (13 of 26) for telogen effluvium. For male pattern hair loss, 79% (n = 23) would prescribe LDOM as monotherapy, mostly used as an adjunct with an oral antiandrogen (n = 13), followed by topical finasteride (n = 9). For female pattern hair loss, 90% (n = 26) would prescribe LDOM as monotherapy and 66% (n = 19) would use it with spironolactone. For FFP/LPP, 79% (n = 23) would not prescribe LDOM as monotherapy, but would use it as an adjunct, most commonly with hydroxychloroquine (n = 20), followed by tetracyclines (n = 19). For alopecia areata (AA), 79% (n = 23) would not prescribe LDOM as monotherapy, and 68% (n = 13) would prescribe it as an adjunct with Janus kinase inhibitors (JAKis). Five of 19 (26%) would commence LDOM at the same time as a JAKi and eight (42%) would only add in LDOM 6–12 months after commencing a JAKi. For telogen effluvium, 52% (n = 15) would use LDOM as monotherapy, and it would rarely be used as an adjunct. Overall, 44% (n = 11) would perform baseline blood tests and 48% (n = 12) would check blood pressure when commencing treatment. Six (21%) would repeat blood pressure and blood monitoring at clinic visits or on dose changes. If it was well tolerated, 76% (19 of 25) would continue LDOM indefinitely and 58% (15 of 26) would discharge a patient from their clinic on an indefinite course of LDOM. Our study highlights the variation in LDOM prescribing within the UK and Ireland. It demonstrates the wide use of LDOM by dermatologists both as an adjunct and as monotherapy for a wide range of hair loss conditions.