Low-Dose Oral Minoxidil Use for Pediatric Hair Disorders

Importance Low-dose oral minoxidil (LDOM) is increasingly used off-label to treat pediatric hair disorders; however, standardized guidance for patient selection, dosing, safety, and monitoring in patients younger than 12 years is lacking. Objective To establish expert consensus recommendations for LDOM use in pediatric patients (age <12 years) with hair disorders. Evidence Review Survey development was informed by a review of the literature on LDOM pharmacology, safety, and clinical use, with emphasis on pediatric populations. A modified Delphi process was conducted from June 30, 2025, to March 7, 2026. Of 98 clinicians completing a prescreening survey, 51 met eligibility criteria (>10 pediatric patients treated with LDOM) and were invited to participate. Three iterative survey rounds were conducted using REDCap with multidisciplinary input. Consensus was defined as 70% or greater agreement on a 5-point Likert scale. Findings Of 51 experts, 50 from 9 countries completed rounds 1 and 2, and 49 (98.0% retention rate) completed round 3, reflecting broad international representation. Of 127 initial items considered, 84 achieved consensus. LDOM is supported for pediatric patients (aged ≥4 to <12 years) for hair follicle miniaturization (100%), hair cycle abnormalities (100%), and hair shaft disorders (84%), with adjunctive use in select scarring alopecia (98%). Preference for LDOM over topical minoxidil included concerns for logistical difficulty, poor tolerability, inadequate efficacy, caregiver preference, diffuse hair loss, sensory sensitivities, or risk of toxic effects in domestic animals (pets) (74%-96%). Both fixed weight-based and mg/kg dosing strategies met consensus. Fixed dosing aligned with available tablet formulations (weight <20 kg, 0.250-0.625 mg; 20-40 kg, 1.250 mg; >40 kg, 1.875 mg [ 80%]), while a starting dosage of 0.01 to 0.02 mg/kg/d (73.5%) provided a flexible alternative. Dosage escalation of 50% to 100% and reassessment every 3 to 6 months reached consensus. Contraindications included pericardial effusion or tamponade and pheochromocytoma. For experts, routine baseline testing and blood pressure monitoring were not universally necessary in patients at low risk. LDOM was supported as long-term therapy with tapering strategies, and as combination therapy with additional agents (eg, spironolactone, corticosteroids, Janus kinase inhibitors, and other immunosuppressants) as appropriate for subtype of hair loss. Conclusions and Relevance This international consensus statement provides a structured, pediatric-specific framework for LDOM use, supporting it as a flexible, nonimmunosuppressive therapeutic strategy and addressing key gaps in dosing, safety, and monitoring.

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Journal
JAMA Dermatology
Published
2026-09-30
DOI
https://doi.org/10.1001/jamadermatol.2026.3749
Primary Topic
Hair Growth and Disorders
Type
article
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article

Low-Dose Oral Minoxidil Use for Pediatric Hair Disorders

Wall Dmitri, Leila Asfour, Rodrigo Pirmez, Nisha S. Desai et al.
JAMA Dermatology
Hair Growth and Disorders
article

Low-Dose Oral Minoxidil Use for Pediatric Hair Disorders

Wall Dmitri, Leila Asfour, Rodrigo Pirmez, Nisha S. Desai, Samantha Eisman, Jennifer Soung, Vijaya Chitreddy, Ilka Arun Netravali, Kimberly S. Salkey, Carol Erin Cheng, Aniza Giacaman, David Saceda‐Corralo, Isabella Doche, Brittany G. Craiglow, Bevin Bhoyrul, Fernanda Bellodi Schmidt, Leonardo Spagnol Abraham, Adriana Rakowska, Yagiz Matthew Akiska, Valerie Dawn Callender, Seth J. Orlow, Paradi Mirmirani, Daniella Kushnir‐Grinbaum, Elise A. Olsen, Bruna Duque‐Estrada, Vikash S. Oza, Maria Gnarra Buethe, Antonellá Tosti, Lisa M. Arkin, Maria Hordinsky, Han Byul Kang, Leslie Castelo-Soccio, Adam Friedman, Shivani Patel, Amy Paller, Michelle Oboite, Rodney Sinclair, Jennifer Fu, Cathryn Sibbald, Maryanne Makredes Senna, Yuliya Ovcharenko, Paulo Müller-Ramos, Megan Craddock, Asim Ali, William Cranwell, Taylor Jamerson, Natasha Mesinkovska, Jackson Turbeville, Kristen I Lo Sicco, Melissa Piliang, Brett King, Karyn Austin, Meredith Steuer, Michelle Tarbox, Erin Mathes, and The Pediatric Low-Dose Oral Minoxidil Consensus Expert Group, Ali Jabbari
article en

Abstract

Importance Low-dose oral minoxidil (LDOM) is increasingly used off-label to treat pediatric hair disorders; however, standardized guidance for patient selection, dosing, safety, and monitoring in patients younger than 12 years is lacking. Objective To establish expert consensus recommendations for LDOM use in pediatric patients (age <12 years) with hair disorders. Evidence Review Survey development was informed by a review of the literature on LDOM pharmacology, safety, and clinical use, with emphasis on pediatric populations. A modified Delphi process was conducted from June 30, 2025, to March 7, 2026. Of 98 clinicians completing a prescreening survey, 51 met eligibility criteria (>10 pediatric patients treated with LDOM) and were invited to participate. Three iterative survey rounds were conducted using REDCap with multidisciplinary input. Consensus was defined as 70% or greater agreement on a 5-point Likert scale. Findings Of 51 experts, 50 from 9 countries completed rounds 1 and 2, and 49 (98.0% retention rate) completed round 3, reflecting broad international representation. Of 127 initial items considered, 84 achieved consensus. LDOM is supported for pediatric patients (aged ≥4 to <12 years) for hair follicle miniaturization (100%), hair cycle abnormalities (100%), and hair shaft disorders (84%), with adjunctive use in select scarring alopecia (98%). Preference for LDOM over topical minoxidil included concerns for logistical difficulty, poor tolerability, inadequate efficacy, caregiver preference, diffuse hair loss, sensory sensitivities, or risk of toxic effects in domestic animals (pets) (74%-96%). Both fixed weight-based and mg/kg dosing strategies met consensus. Fixed dosing aligned with available tablet formulations (weight <20 kg, 0.250-0.625 mg; 20-40 kg, 1.250 mg; >40 kg, 1.875 mg [ 80%]), while a starting dosage of 0.01 to 0.02 mg/kg/d (73.5%) provided a flexible alternative. Dosage escalation of 50% to 100% and reassessment every 3 to 6 months reached consensus. Contraindications included pericardial effusion or tamponade and pheochromocytoma. For experts, routine baseline testing and blood pressure monitoring were not universally necessary in patients at low risk. LDOM was supported as long-term therapy with tapering strategies, and as combination therapy with additional agents (eg, spironolactone, corticosteroids, Janus kinase inhibitors, and other immunosuppressants) as appropriate for subtype of hair loss. Conclusions and Relevance This international consensus statement provides a structured, pediatric-specific framework for LDOM use, supporting it as a flexible, nonimmunosuppressive therapeutic strategy and addressing key gaps in dosing, safety, and monitoring.

JAMA Dermatology
University College Dublin (IE), Northwestern University (US), University of Iowa (US), University of Maryland, Baltimore (US), MedStar Washington Hospital Center (US), Lahey Hospital and Medical Center (US), University of Minnesota (US), Children's Hospital of Orange County (US), Cleveland Clinic (US), Children's Hospital of Philadelphia (US), Children's National (US), University of Wisconsin–Madison (US), Harvard University (US), Howard University (US), University of Miami (US), Emory University (US), University of California, Los Angeles (US), The University of Melbourne (AU), Universidade de São Paulo (BR), University of California, San Francisco (US), Virginia Commonwealth University (US), University of Toronto (CA), George Washington University (US), Los Angeles Harbor College (US), University of California, Irvine (US), Medical University of Warsaw (PL), Chelsea and Westminster Hospital NHS Foundation Trust (GB), Kelsey-Seybold Clinic (US), Hospital de Base (BR), Hospital for Sick Children (CA), Mater Misericordiae University Hospital (IE), Yale University (US), Lahey Medical Center (US), Oregon Dermatology & Research Center (US), Rappaport Family Institute for Research in the Medical Sciences (IL), California Urological Association (US), Medecell (Brazil) (BR), Kaiser Permanente Vallejo Medical Center (US), Duke Medical Center (US), Instituto Ramón y Cajal de Investigación Sanitaria (ES), Institute of Dermatology (TH), Iowa City VA Medical Center (US), Stanford Medicine (US), Dermatology Associates of Seattle (US), Sinclair Dermatology (AU), Hospital Universitario Son Espases (ES), New York University (US), Virginia Commonwealth University Medical Center (US), University of Pennsylvania (US), V. N. Karazin Kharkiv National University (UA), Universidade Estadual Paulista (Unesp) (BR), Texas Tech University Health Sciences Center (US), Stanford University (US)
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Hair Growth and Disorders
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