Topical Minoxidil and Autoimmune Disease: What Clinicians and Patients Need to Know

What do the labels say about autoimmune-pattern hair loss?

The men's 5% solution label says to use it to regrow hair on the top of the scalp (vertex only), and the women's 5% foam label says the same for the top of the scalp [3][2]. Both labels say not to use the product when hair loss is sudden and/or patchy, when the cause of hair loss is unknown, when there is no family history of hair loss, when the scalp is red, inflamed, infected, irritated or painful, or when other medicines are used on the scalp [3][2].

What did the alopecia areata trial show?

Price (J Am Acad Dermatol 1987) enrolled 30 people aged 9 to 65 with extensive patchy alopecia areata (more than 50% scalp hair loss), alopecia totalis or alopecia universalis. A 3% solution or placebo went on half of the affected scalp twice daily, under overnight petrolatum occlusion, for one year [4].

Hair growth occurred in 7 of 11 evaluable minoxidil subjects (63.6%) and 5 of 14 on placebo (35.7%). Cosmetically acceptable growth occurred in 3 of 11 (27.3%) versus 1 of 14 (7.1%) [4]. Thirty people in one study is a small sample, and the trial tested a 3% solution, while the over-the-counter Rogaine products discussed here are 2% and 5% [4][1][3][2].

Do immunosuppressant drugs interact with topical minoxidil?

The labels simply do not address prescription immunosuppressants such as methotrexate, hydroxychloroquine, azathioprine, mycophenolate or JAK inhibitors. They say not to use the product if you use other medicines on the scalp [3][2].

Bottom line

Topical minoxidil is an over-the-counter hair regrowth product, and its labels do not address autoimmune conditions [3][2]. The only autoimmune-related trial in the evidence is the small 1987 alopecia areata study [4].