New Uses: Old medicine helps to cure baldness

NEW YORK.— Advertisements are everywhere, with exaggerated claims: there are Shampoos and special treatments, sometimes thousands of dollars, to grow hair. HoweverMany dermatologists who specialize in hair loss say that most of these products don’t work.

Brett King, a dermatologist at the Yale School of Medicine, says, “There are endless ineffective hair growth solutions that cost a lot of money, but because people are desperate, hair growth continues. A lot.”

However, according to him and other dermatologists, It costs pennies a day and is a cheap hair restoration treatment for many patients. about this MinoxidilAn old and well-known remedy for hair loss used in a very different way. Instead of applying it directly to the scalp, it is recommended in very small doses.

Although a growing group of dermatologists offer low-dose minoxidil tablets, the treatment is relatively unknown to most patients and many doctors. It is not approved by the US Food and Drug Administration (FDA, its abbreviation in English) For this purpose, therefore It is recommended outside of what is stated in its data sheet, which is a common practice in the field of dermatology.

“I invite us Pirates of unauthorized products that I am proud to usesaid Adam Friedman, MD, professor and chair of dermatology at George Washington University. He explained that dermatologists are trained to understand how drugs work. Allows them to test unapproved drugs. Often in dermatology it is clear whether a treatment is working: does the rash go away or not?

Robert Sverlick, professor and chair of the department of dermatology at Emory University School of Medicine, agrees. “I tell people that Most of what we recommend is off-label because that use is not indicated on the label“, said. Sverlik provided a long list of conditions, such as skin pigmentation disorders, inflammatory skin disorders and chronic itching, for which standard treatments are not approved according to their labeling.

Minoxidil, the active ingredient in Rogaine, a lotion or foam rubbed on the scalp, first approved for men in 1988 and then for women in 1992, is now generic. Use of the drug as a treatment for hair growth Discovered decades ago by accident. High-dose minoxidil pills were used to treat high blood pressure, but patients often found that the pills caused hair growth all over their bodies. So its manufacturer created Minoxidil lotion (also known as Rogaine) and approved it to grow hair on bald heads.

However, dermatologists say lotion or foam Not very effective for some patients, perhaps they stop using it. It has to get itself to the scalp and gets in the way of the hair. Many people, especially women, stop using it because they don’t want to leave a sticky substance on their hair.

Johnson & Johnson, which currently owns Rogaine, did not respond to requests for comment.

Others think it won’t work for them. Have minoxidil Converted to active form by sulfotransferase enzymesIt may or may not be present in sufficient quantity at the roots of the hair. When the drug is taken orally, it automatically takes the active form.

However, that was not the reason for the discovery of the low-dose pills, rather the discovery happened by accident 20 years ago.

Rodney Sinclair, a professor of dermatology at the University of Melbourne, Australia, had a woman with hair loss. The hair on the top of his head was thinning and she hated the way he looked. Unlike most of his patients, Rogaine worked for him, but he developed an allergic scalp rash from the drug; However, if he stops taking it, his hair will thin out again.

“So I was in a dilemma,” Sinclair said. “The patient is very motivated, and what we know is that if a patient is allergic to a topical medication, one way to desensitize them is to give them very low doses orally.”

To do so, Sinclair tried cutting minoxidil pills into quarters. To his surprise, the low dose made his hair grow but didn’t affect his blood pressure, which was the original target of the high dose.

Then, he gradually reduced the dose until he reached an effective dose of one-fortieth of a pill and began prescribing the drug regularly. That first patient is still taking it.

In A meeting was held in Miami in 2015Sinclair reported that low-dose minoxidil caused hair growth in 100 women.

Sinclair General Those results in 2017, he noted, called for rigorous studies in which some patients were randomly prescribed minoxidil and others a sugar pill, but that didn’t happen. He said that he has treated more than 10,000 patients so far.

Recently, the number of dermatologists specializing in hair loss is increasing A reduced dose of pills is recommended for patients with male and female pattern hair loss, which is a normal phenomenon with aging..

“The popularity is starting to grow,” says Crystal Akuh, MD, a dermatologist at the Johns Hopkins School of Medicine. “At conferences, we often share our success stories.”

Doctors who do not specialize in hair loss, he added, “Oral minoxidil is not well known” except as a very rarely used treatment for high blood pressure. And it comes with a warning that it can cause heart problems. According to her and other experts, the caveat is for higher doses.

If the hair loss is severe, minoxidil won’t help, Akuh said. “For example, if a man has a mostly bald, shiny scalp it won’t work. There’s nothing to salvage.” The ideal patient is not completely bald, he said, but has lost enough hair that even a casual observer would notice.

However, without rigorous testing leading to FDA approval, minoxidil pills for hair loss are off-label for that use.And, according to dermatologists, it will continue.

“Oral minoxidil costs pennies a day,” King said. “There is no incentive to spend millions of dollars to test it in a clinical trial. In fact, that study will never be done.

Some patients notice unwanted hair growth on their face and chin even when taking low doses of minoxidil. So some dermatologists, including Sinclair, have added another drug—a very low dose of spironolactone—that blocks certain sex hormones called androgens to prevent unwanted hair growth.

Patients who don’t want to go the off-label route can turn to what some dermatologists say are ineffective over-the-counter remedies or one of two FDA-approved hair growth products.

These two products are Rogaine and finasteride, a common drug used in high doses in men to treat benign enlargement of the prostate. As a hair loss remedy, it is only approved for men. It is linked to sexual dysfunction.

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

“I saw miracles,” said Akuh. One of them was with Brandi Gray, who is 44 years old and lives in Moncton, Maryland. “Over time I lost my hair,” she said. “Then I start having circular holes”, without hair. “They just kept getting worse.” She has consulted another dermatologist, who has prescribed shampoos and supplements, without success. Finally, she says her dermatologist told her: “There’s nothing more I can do for you, there’s nothing else I can do.” He went to Akuh who prescribed low dose minoxidil. Ten months later, her hair was thick and abundant. “I can style my hair in different ways,” she said. “I don’t wear wigs anymore.” I have never experienced hair loss like this.

Por Gina Kolata