To The Editor:
Hair loss, specifically androgenetic alopecia (AGA), is a common outpatient dermatology complaint. AGA occurs in men and women, results from the effect of dihydrotestosterone miniaturizing scalp follicles, and commonly presents with thinning of the bitemporal, frontal, and vertex scalp.1
Numerous studies have demonstrated that topical minoxidil is an effective and relatively safe treatment for male and female AGA.2 Although only Food and Drug Agency (FDA)-approved for use in AGA, topical minoxidil has also been used for other forms of both non-scarring and scarring alopecia, such as alopecia areata and central centrifugal cicatricial alopecia.3,4 Despite its known efficacy, the authors' anecdotal clinical experience finds patients reluctant to try minoxidil for a multitude of reasons including cost, perceived lack of effectiveness, and concern about side effects.
The purpose of this study was to identify attitudes, perceptions, and barriers-to-care related to the use of topical minoxidil in patients with hair loss. This was a prospective survey of patients at the George Washington University (GWU) Dermatology Department who presented to clinic with a complaint of hair loss or alopecia. This study was approved by the GWU Institutional Review Board #051755.
A total of 93 surveys were completed. Demographic data of respondents are shown in Table I. Most of the respondents were female (78.5%), self-identified as African-American (41.9%), and had suffered from hair loss for >5 years (35%). 79.6% of respondents were aware of minoxidil, though only 15.1% of those aware were currently using minoxidil and 20.4% had used it in the past. Current or past users were asked to rate their satisfaction with minoxidil on a Likert scale of 1 (very unsatisfied) to 5 (very satisfied). The average satisfaction score of all current and past users was 2.78 ± 1.18, with current users reporting higher satisfaction (3.50 + 0.65) than past users (2.22 ± 1.22).
Respondents were asked why they had never tried minoxidil or why they had tried minoxidil and stopped (Table 2). The most common reason for never trying minoxidil was concern for unwanted side effects (39%), followed by cost concerns (29%) and concern for life-long use (27%). Lack of effectiveness was the main reason cited for stopping minoxidil (13 of 19 respondents). Of these 13 respondents, 9 reported using minoxidil for less than 6 months, with the remaining 4 reporting at least 6 to 12 months of use. Cost (47%) and life-long use (32%) were also significant concerns for previous users, and, despite the concerns of the never used group, only 21% said they had experienced unwanted side effects.
Our study revealed that some of the common barriers to minoxidil include fear of side effects, concern for life-long use, and lack of effectiveness. Minoxidil is an effective treatment option for AGA with a low side-effect profile.2 It should be stressed to patients that it may take up to a year to see the maximum results of minoxidil use.5 While life-long treatment is necessary for AGA, it may be helpful to counsel concerned patients that regular use of minoxidil will lead to the most benefit, much like brushing one's teeth or sunscreen use.6 Understanding the potential barriers, and addressing these preconceptions at the onset of recommending minoxidil, may promote better compliance with treatment recommendations.
Hair loss, specifically androgenetic alopecia (AGA), is a common outpatient dermatology complaint. AGA occurs in men and women, results from the effect of dihydrotestosterone miniaturizing scalp follicles, and commonly presents with thinning of the bitemporal, frontal, and vertex scalp.1
Numerous studies have demonstrated that topical minoxidil is an effective and relatively safe treatment for male and female AGA.2 Although only Food and Drug Agency (FDA)-approved for use in AGA, topical minoxidil has also been used for other forms of both non-scarring and scarring alopecia, such as alopecia areata and central centrifugal cicatricial alopecia.3,4 Despite its known efficacy, the authors' anecdotal clinical experience finds patients reluctant to try minoxidil for a multitude of reasons including cost, perceived lack of effectiveness, and concern about side effects.
The purpose of this study was to identify attitudes, perceptions, and barriers-to-care related to the use of topical minoxidil in patients with hair loss. This was a prospective survey of patients at the George Washington University (GWU) Dermatology Department who presented to clinic with a complaint of hair loss or alopecia. This study was approved by the GWU Institutional Review Board #051755.
A total of 93 surveys were completed. Demographic data of respondents are shown in Table I. Most of the respondents were female (78.5%), self-identified as African-American (41.9%), and had suffered from hair loss for >5 years (35%). 79.6% of respondents were aware of minoxidil, though only 15.1% of those aware were currently using minoxidil and 20.4% had used it in the past. Current or past users were asked to rate their satisfaction with minoxidil on a Likert scale of 1 (very unsatisfied) to 5 (very satisfied). The average satisfaction score of all current and past users was 2.78 ± 1.18, with current users reporting higher satisfaction (3.50 + 0.65) than past users (2.22 ± 1.22).
Respondents were asked why they had never tried minoxidil or why they had tried minoxidil and stopped (Table 2). The most common reason for never trying minoxidil was concern for unwanted side effects (39%), followed by cost concerns (29%) and concern for life-long use (27%). Lack of effectiveness was the main reason cited for stopping minoxidil (13 of 19 respondents). Of these 13 respondents, 9 reported using minoxidil for less than 6 months, with the remaining 4 reporting at least 6 to 12 months of use. Cost (47%) and life-long use (32%) were also significant concerns for previous users, and, despite the concerns of the never used group, only 21% said they had experienced unwanted side effects.
Our study revealed that some of the common barriers to minoxidil include fear of side effects, concern for life-long use, and lack of effectiveness. Minoxidil is an effective treatment option for AGA with a low side-effect profile.2 It should be stressed to patients that it may take up to a year to see the maximum results of minoxidil use.5 While life-long treatment is necessary for AGA, it may be helpful to counsel concerned patients that regular use of minoxidil will lead to the most benefit, much like brushing one's teeth or sunscreen use.6 Understanding the potential barriers, and addressing these preconceptions at the onset of recommending minoxidil, may promote better compliance with treatment recommendations.
