Date of Award

2014

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department Chair

John Cavenagh, PhD, PA-C

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not minoxidil is efficacious and safe for the treatment of androgenetic alopecia (AGA) in men, and if so, what is the optimal strength and means of delivery.

STUDY DESIGN: Review of three double-blind randomized controlled trials studying men (18-49 y/o) with androgenetic alopecia published in English from 2007-2009.

DATA SOURCES: Three articles of double-blind randomized controlled trials found via PubMed.

OUTCOMES MEASURED: Outcomes measured included the efficacy and safety of minoxidil as well as the optimal strength and means of delivery of the drug. For efficacy, parameters used included target area hair count (TAHC), subject assessment using rating scale, expert panel or investigator assessment via photographic review and then rated on the same scale used by subjects. To assess safety, the studies used subject report of symptoms of scalp irritation, investigator examination of signs of scalp irritation, and change in vital signs and/or abnormal lab values for systemic effects. As for the optimal strength and means of delivery, this was evaluated based on the way each study was designed. In the Olsen study, 5% minoxidil foam applied twice daily was compared to a placebo, while the Tsuboi study compared application of 5% minoxidil lotion to 1% minoxidil lotion with both also applied twice daily, and the Shin study compared the use of a placebo in the morning and 5% minoxidil/0.01% tretinoin in the evening against twice daily application of 5% minoxidil alone.

RESULTS: The Olsen and Tsuboi studies demonstrated that 5% minoxidil applied twice daily was efficacious without significant adverse effects when compared to placebo or 1% minoxidil respectively, and the Shin study raised the possibility of combined 5% minoxidil/0.01% tretinoin to obtain similar efficacy without significant adverse effects with only once daily usage.

CONCLUSION: Minoxidil is safe and efficacious in the treatment of male AGA especially at the strength of 5% in either foam or solution preparation for twice daily use.

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