A Pharmacist's Guide to OTC Hair Loss Products

Androgenic alopecia is the only form of hair loss with FDA-approved nonprescription treatments.

Androgenetic alopecia, commonly known as male-pattern baldness, is the most common form of hair loss for both men and women. It can be caused by either hormonal or hereditary factors and is the only form of hair loss for which the FDA has approved the use of nonprescription hair loss products.¹

Androgenetic alopecia is an androgendependent hereditary disorder in which dihydrotestosterone is a significant contributing factor.² The condition affects Caucasian men more than men of other ethnicities. It can start at any age, but approximately 30% of men will experience some hair loss by the age of 30 years, 50% by the age of 50 years, and 80% by the age of 70 years.¹

In addition, up to 13% of premenopausal women experience some degree of androgenetic alopecia, and the incidence may increase significantly after menopause.⁴ By the age of 70 years, approximately 40% to 50% of women experience hair loss.^1,3

Signs and Symptoms of Hair Loss

Unlike those affected by other types of hair loss, patients with androgenetic alopecia experience gradual hair loss with no signs of inflammation or scarring. Men with androgenetic alopecia tend to experience hair loss beginning at the temples and crown, and some men may experience partial or complete baldness.¹

Women with the condition typically experience thinning of the hair at the front of the hairline as well as at the sides or crown.¹ Women experiencing this type of hair loss may also have severe acne, hirsutism, menstrual irregularities, and infertility due to hyperandrogenism.¹ Women experiencing these symptoms should be referred for medical evaluation to find out the cause of their hair loss before treatment with OTC products.

Nonprescription Products

Topical formulations of minoxidil 2% and 5% are the only FDA-approved nonprescription products available for the treatment of androgenetic alopecia.¹ Minoxidil is available as a topical hydroalcoholic solution or solvent-free foam. The 2% formulation is indicated for treatment of baldness at the crown of the head in men and treatment of thinning of hair at the frontoparietal region in women.¹ Topical minoxidil 2% can be used in both men and women, but 5% topical minoxidil is indicated for use by men only.¹ Use of 5% minoxidil by women is contraindicated due to an increased risk of facial hair growth.¹

Although its exact mechanism of action is unknown, minoxidil appears to increase cutaneous blood flow directly to the hair follicles, which in turn increase in size after treatment. The medication also promotes and maintains vascularization of hair follicles in alopecia.^1,4,5 Minoxidil’s efficacy in treating other types of hair loss, such as alopecia areata, is not well established, but some patients with these conditions have reported successful use of minoxidil products.¹ Patients with sudden hair loss or nonpattern hair loss should always be encouraged to seek medical advice before using minoxidil products.

There are no known drug interactions associated with the use of topical minoxidil. However, it is important to note that the concurrent use of minoxidil with guanethidine may increase the incidence of orthostatic hypotension.^1,4 Because topical minoxidil is absorbed through the skin in low concentrations, the incidence of systemic adverse effects is rare. The most common adverse effects associated with the long-term use of topical minoxidil are transient hypertrichosis and local itching or irritation.^1,2 Minoxidil should only be used by patients 18 years and older.

Counseling Patients with Hair Loss

Because hair loss may cause emotional distress and affect self esteem, health care professionals should be supportive and empathetic to patients experiencing it. Pharmacists can assist patients experiencing hair loss by reviewing medication profiles and possibly identifying pharmacologic agents that may be associated with increased risk of hair loss. Prior to recommending the use of topical minoxidil products, it is important to determine whether self-treatment is appropriate and whether the cause of the hair loss has been identified.

Patients should always be referred to their primary care physician for further evaluation if the cause of their hair loss is unknown or sudden. It is particularly important for women who experience sudden hair loss to seek counsel from their primary care physician to identify causes or contributing factors.¹

To ensure that their medication is effective, patients should be counseled on how to properly apply topical minoxidil according to manufacturer recommendations.^1,3 Patients should also be made to understand the importance of using the product continuously to maintain regrowth of hair, because discontinuation of treatment can result in a rapid reversion to the pretreatment balding pattern.^1,4

Patients should be advised to not apply the product more than twice a day and not to apply it to damaged or inflamed areas of the skin.¹ The product should also not be applied 24 hours before or after the use of a hair color, relaxer, or permanent.¹

Pharmacists should also inform patients that the product may not be effective for everyone, that it is a suppressive therapy and not a cure, and that hair growth may not be apparent until 4 months after initiation of therapy.^1,3 If hair growth does not occur after 4 to 6 months of consistent use, the patient should be advised to discuss other possible treatments with their primary health care provider.

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

References

• Berry T. Hair loss. In Krinsky D, Berardi R, Ferreri S. et al, eds. Handbook of Nonprescription Drugs. 17th ed. Washington, DC: American Pharmacists Association; 2012.
• Alopecia. Merck Manuals Online Library for Healthcare Professionals website. www.merck.com/mmpe/sec10/ch124/ch124b.html?qt=minoxidil&alt=sh#sec10-ch124-ch124b-975.
• Understanding hair loss. Rogaine website. www.rogaine.com/men/understanding-hair-loss.
• Feinstein R. Androgenetic alopecia: treatment and medication. Medscape website. http://emedicine.medscape.com/article/1070167-treatment.
• Rogaine product information. Rogaine website. www.rogaine.com.