Minoxidil

It was marketed under the name Loniten by its manufacturers, the Upjohn Company (now Pharmacia and Upjohn Ltd) from their giant pharmaceutical plant in Kalamazoo, Michigan. For several years, this highly respectable company ignored the drug's potential for growing hair. It was not keen on anything so cosmetic as a "cure for baldness": its reputation hinged on serious medicine. But news of the hair-growth factor leaked when a cardiac physician, Dr Anthony Zappacosta reported in the New England Journal of Medicine that one of his patients, a bald man of 38, had regrown hair while taking the, drug for his heart condition. Dermatologists were soon involved in world-wide trials. They applied a solution containing a tiny percentage of minoxidil to the scalp. Volunteer guinea pigs - all with balding heads - queued up to try it in the US, Denmark the UK, all of them desperate to find out whether the miracle worked. I was a guinea pig in the UK, prescribed minoxidil at one of London's teaching hospitals: first, a 2 per cent solution, then 3 per cent. Soon tiny hairs appeared in the bald patches on my scalp. They also grew a little on my face. The doctor thought I had splashed it too generously on my scalp and it had run down the sides of my face. The hair had grown there, just as it had on my face. He added that usually the drug only made hair grow in the wrong places when taken by mouth. I was not complaining! I was delighted that the solution was helping to thicken up the regrowth on my scalp In any case, the facial hair soon disappeared. But what was the minoxidil miracle all about? Everyone one was asking about it. Some doctors hailed it as a breakthrough. The widespread research it prompted could only be a good thing and encourage more medical interest in alopecia areata. The minoxidil saga, said the doctors, is a modern fairy tale.

How Was Minoxidil's Potential for Hair Growth Discovered?
Over 25 years ago, rninoxidil began life as a metabolite breakdown product extracted from rats' urine, intended as an anti-ulcer medication which would act on gastric solutions. But it was more use to the heart than the stomach, discovered its manufacturers, the Upjohn Company, pharmaceutical firm founded over a hundred years ago by Dr William Erasmus Upjohn, whose grandfather was English. They soon found out that it was a strong vasodilator, funded research, and by 1979 the US Food and Drug Administration (FDA) approved its use for the treatment of high blood pressure, under the trade name of Loniten. But during these trials some patients grew hair in odd places. A young doctor experimented privately by making up a solution of crushed minoxidil tablets and applying it to the heads of his bald friends. He took out a patent on its use as a hair restorer. The company apologized to the FDA for the incident and took out a separate hair use patent, promising that, in future, it would be used only as a blood pressure drug; but heart physician Dr Zappacosta's sudden revelation in the medical press dragged the subject into the open again. Upjohn launched trials into minoxidil's use as a hair restorer. It was tested on macaque monkeys, who usually lose their hair at adolescence. Three out of four adult monkeys ended up with thickening hair. State prisoners volunteered to take part in the trials, as did thousands in hospitals in New York and Washington. Cosmetically significant regrowth was reported in about a third of volunteers.

Now Is Minoxidil Used?
For clinical trials, hospitals made up their own preparations: a tiny percentage of the drug (from 1 to 5 per cent) in an alcohol solution. The patient applies this to the bald area twice daily.

How Soon Can Reqrowth Be Expected?
Within four months... if it is going to work in your case! Dermatologist Dr John Wilkinson cautions: "It is not a cure for baldness and it appears that only one in three patients obtains significant benefit. It is also expensive".

Does Minoxidil Work for Everyone?
No. Clinical trials have found that it works best on early male pattern baldness and patchy alopecia areata. It has not been very successful on totally bald heads. In a major British trial, Dr David Fenton of St Thomas's Hospital, London, and Dr John Wilkinson of the Wycombe General Hospital, High Wycombe, concluded: Although we have little doubt that topical minoxidil can induce new hair growth in patients with alopecia areata, those with more severe and extensive disease have a worse response. Those with alopecia universalis and alopecia totalis may not respond at all.

Is Minoxidil Safe?
For a 1 per cent topical solution, Fenton/Wilkinson, UK, said: "so far no side-effects". Dr John Wilkinson adds: "Long-term risks have yet to be established". Chicago reported "no side-effects", and Sunderland's verdict was "safe, convenient and effective". Mild skin irritations were reported in one study in the US. Two Aberdeen patients had to give up the treatment due to dermatitis. Doctors wondered whether the fact that they were wearing wigs was connected. A Manchester woman on 3 per cent minoxidil developed palpitations and chest pain but recovered when returned to 1 per cent. Doctors suggested she might have been applying the lotion too liberally with the customary enthusiasm of alopecia patients. They advised caution in the use, of higher concentrations of minoxidil in patients with extensive alopecia areata and those with known coronary heart disease. No patients died during the trials but five deaths were reported in the US among the thousand who continued using it under their own doctor's supervision. There were also five further deaths, two in Upjohn alopecia areata studies and two among users of non-Upjohn minoxidil formulations. The tenth death was that of a man who had been in a study for patients taking blood pressure drugs by mouth. He was on active drugs for 16 days then dropped out of the study. He died two months later.

It was quite clear that all the deaths were caused by reasons other than the patients' use of minoxidil, the causes including such serious conditions as AIDS and heart - cardiovascular - complaints. The patients' use of minoxidil was purely coincidental and any public scares about the drug were quite unjustified! All the cases were reported to the American Food and Drug Administration and Upjohn says that minoxidil did not have, anything to do with the deaths. The volunteers underwent exhaustive medical checks throughout the trials. While patients on the 3 per cent concentration had higher minoxidil blood levels than those on the 2 per cent, observed levels were low and not clinically significant. When prescribed for hair growth minoxidil became known as Regaine.