An international panel of hair loss experts reached a consensus on the off-label use of low-dose oral minoxidil for treating various types of alopecia, according to a modified Delphi consensus statement published in JAMA Dermatology.

The panel, consisting of 43 dermatologists from 12 countries with expertise in hair disorders, agreed that low-dose oral minoxidil (LDOM) may provide direct benefits for androgenetic alopecia, age-related patterned thinning, alopecia areata, telogen effluvium, traction alopecia, persistent chemotherapy-induced alopecia, and endocrine therapy–induced alopecia. They also concurred that LDOM may offer supportive benefits for cicatricial alopecias such as lichen planopilaris, frontal fibrosing alopecia, central centrifugal alopecia, and fibrosing alopecia in a patterned distribution.

The experts reached a consensus on dosing considerations, with commonly prescribed starting doses of 1.25 mg/day among adult women, 2.5 mg/day among adult men, 0.625 mg/day among adolescent girls, and 1.25 mg/day among adolescent boys. Dosing ranges spanned from 0.625 to 5 mg/day depending on patient characteristics. Contraindications included congestive heart failure, pericardial disease, pulmonary hypertension with mitral stenosis, pheochromocytoma, and pregnancy or lactation. The panel considered kidney impairment and hypotension to be precautions.

Baseline blood pressure and electrocardiogram evaluations were not deemed routinely necessary in the absence of precautions. The consensus statement also addressed efficacy expectations, adverse effect monitoring, and the role of specialty consultation.

Conflict of interest disclosures can be found in the consensus statement.