INTRODUCTION
Low-dose oral minoxidil (LDOM) is being increasingly prescribed off-label as an adjunct treatment for alopecia.1 Historically, minoxidil has primarily been used as a treatment for severe, refractory hypertension due to its potent vasodilating properties. When prescribed at anti-hypertensive dosages (10-40 mg daily), minoxidil is associated with pericardial effusions that may progress to cardiac tamponade, leading to an FDA-mandated black box warning.2,3 Conversely, its side effect profile at low doses (up to 5 mg daily) in patients with alopecia has generally proven to be mild.1 However, a recent report of anasarca and pericardial effusion developing shortly after initiating LDOM therapy in a healthy woman with frontal fibrosing alopecia has prompted concern within the dermatology community for potentially serious complications.4 Additionally, two patients at our institution were incidentally diagnosed with pericardial effusions, prompting their care team to discontinue LDOM [NAM]. These findings raise the question of whether this now widely prescribed medication predisposes certain individuals to pericardial effusions even at the low dosages used for alopecia.
In this study, an association between LDOM therapy and pericardial effusions was evaluated by using ultrasound to compare the frequency of pericardial effusions in alopecia patients on LDOM therapy compared to those not on LDOM.
In this study, an association between LDOM therapy and pericardial effusions was evaluated by using ultrasound to compare the frequency of pericardial effusions in alopecia patients on LDOM therapy compared to those not on LDOM.
MATERIALS AND METHODS
Between January and April 2023, a sample of consecutive alopecia patients were imaged with non-diagnostic, ultrasound screening for pericardial effusions at an academic dermatology clinic.
For point-of-care ultrasound, the Terason uSmart 3300 (Teratech Corporation, Burlington, MA) ultrasound imaging system (version 5.14.4) was used throughout the entirety of the study. Patients were laid into a supine position and a subxiphoid window was obtained using a curved array transducer.5 Ultrasound scans were independently evaluated for the presence and size of pericardial effusions by two board-certified cardiologists (IP, ED). Effusions were graded according to published guidelines. The largest diameter echo-free space between the visceral and parietal
For point-of-care ultrasound, the Terason uSmart 3300 (Teratech Corporation, Burlington, MA) ultrasound imaging system (version 5.14.4) was used throughout the entirety of the study. Patients were laid into a supine position and a subxiphoid window was obtained using a curved array transducer.5 Ultrasound scans were independently evaluated for the presence and size of pericardial effusions by two board-certified cardiologists (IP, ED). Effusions were graded according to published guidelines. The largest diameter echo-free space between the visceral and parietal
