Oral Minoxidil Media Coverage: The Impact on Patient Perceptions and Practitioner Approaches to Androgenetic Alopecia

Furthermore, weekly RSV values for selected health-related terms LDOM and PHL exhibited trivial fluctuations 6 months prior to August 2022, averaging at RSV < 25 and RSV < 50, accordingly. AGA RSV values demonstrated greater variability; web searches peaked at 97 during the week of March 27th-April 2nd, 2022, plummeted to 23 during the first week of May 2022, and again ascended to 47 during the week of June 26th-July 2nd, 2022, coinciding with the same dates baricitinib received FDA approval for alopecia areata. Google Analytics following the release of the NYT article on August 18th, 2022, showed notable peaks in LDOM, PHL, and AGA RSV values at 100, 37, and 73, respectively, during the week of August 14th-20th, 2022, corresponding to popular culture news. Nonetheless, those numbers returned to their baseline RSV values within 4 weeks and have continued to demonstrate minimal oscillations as of September 18th, 2022.

We demonstrated that patient interest in LDOM has increased substantially, with 71% of nationwide Dermatologist respondents claiming upsurges in medication inquiry and prescription numbers surpassing 85% total increases since August 18th, 2022. While authors of the NYT publication were strong proponents of LDOM attesting that it restored hair growth amidst several patients, no information was offered about its ideal dosing, treatment duration, adverse effects, and if efficacy was achieved with monotherapy or in combination with other medications. In reviewing recent literature, studies suggest that optimal safe doses of LDOM range between 0.625mg and 5mg daily, with the expectation to be used lifelong. 1.25mg and 2.5mg tablets are the most commonly prescribed dosages, though they are often adjusted in congruence with patient AGA severity.^1,4 Furthermore, six meta-regression analyses from other studies assessing LDOM efficacy demonstrated there exists a positive dose-dependent relationship that contributes significantly and results are best observed at 24 weeks following treatment initiation. For example, increasing an LDOM dose by 1mg/day was associated with sex-adjusted increases in total hair density (mean difference = 47.1 hairs/cm², P = 0.007), terminal hair density (mean difference = 9.1 hairs/cm², P = 0.001), and hair diameter (mean difference = 1.4 micrometers, P = 0.01).⁴ However, investigators also witnessed dose-dependent risks of hypertrichosis, pedal edema, and cardiovascular events.⁴ Fortunately, Dermatologists are comfortable using LDOM as an adjunctive treatment with other 5-alpha reductase inhibitors, including finasteride and dutasteride, to elicit maximal effects and improve long-term patient adherence.^2,5 Together, these data highlight the impact media can have on patient education and care-seeking behaviors and resulting practice trends. It is of the utmost importance that a collaborative and evidence-based approach be taken between journalists and health care practitioners to ensure that the widely disseminated information is realistic and evidence based.

The authors have no conflicts of interest to declare.

Adam Friedman MD FAAD ajfriedman@mfa.gwu.edu