INTRODUCTION
Alopecia is a chronic debilitating disease. Topical minoxidil is the only FDA-approved treatment for both female and male pattern hair loss (androgenetic alopecia); it is also used off-label to treat alopecia areata and forms of scarring alopecia.1 Low adherence to topical minoxidil is a major barrier to efficacy. Research has investigated novel delivery approaches and photographic assessments to improve adherence.2,3 However, no study has evaluated characteristics of alopecia patients based on adherence to topical minoxidil. In this study, we identified characteristics of and attitudes toward treatment in both adherent and non-adherent patients with the goal of elucidating factors associated with adherence and providing clinicians with specific targets to promote positive behavior.
MATERIALS AND METHODS
Study Design
A cross sectional study was conducted between October 2018 and April 2019 using data collected from a sample of 99 adults with a history of alopecia. Patients were recruited in person from a specialty hair loss clinic. All patients completed a survey assessing demographics and aspects of treatment adherence. Patients currently using minoxidil additionally completed a survey grading their level of adherence according to the Morisky, Green, and Levine (MGL) Adherence Scale.4 Inclusion criteria were age 18 years or older, a diagnosis of one of the following: central centrifugal cicatricial alopecia (CCCA), traction alopecia (TA), androgenetic alopecia (AGA), frontal fibrosing alopecia (FFA) or lichen planopilaris (LPP), and history of current or prior topical minoxidil use. Participants were excluded if they did not select one or more of the aforementioned types of alopecia. Ethical approval to conduct the study was obtained from the Institutional Review Board (IRB) of Wake Forest University in Winston-Salem, North Carolina. Participation in the study was voluntary and written informed consent was obtained from the participants.
Study Population, Covariates, and Outcome Variable
Covariates included demographic characteristics (age, sex, race, educational level, marital status, yearly household income), alopecia diagnosis (CCCA, TA, AGA, FFA, LPP), and adherence factors (duration of topical minoxidil use, perceptions of treatment efficacy, rationale for discontinuing therapy if applicable). The outcome variable was adherence. Adherence as a dichotomous variable was based on whether patients reported current minoxidil use (adherent) or previous minoxidil use (non-adherent). Additionally, level of adherence was assessed in adherent patients based on the MGL scale score (low, medium, or high).
A cross sectional study was conducted between October 2018 and April 2019 using data collected from a sample of 99 adults with a history of alopecia. Patients were recruited in person from a specialty hair loss clinic. All patients completed a survey assessing demographics and aspects of treatment adherence. Patients currently using minoxidil additionally completed a survey grading their level of adherence according to the Morisky, Green, and Levine (MGL) Adherence Scale.4 Inclusion criteria were age 18 years or older, a diagnosis of one of the following: central centrifugal cicatricial alopecia (CCCA), traction alopecia (TA), androgenetic alopecia (AGA), frontal fibrosing alopecia (FFA) or lichen planopilaris (LPP), and history of current or prior topical minoxidil use. Participants were excluded if they did not select one or more of the aforementioned types of alopecia. Ethical approval to conduct the study was obtained from the Institutional Review Board (IRB) of Wake Forest University in Winston-Salem, North Carolina. Participation in the study was voluntary and written informed consent was obtained from the participants.
Study Population, Covariates, and Outcome Variable
Covariates included demographic characteristics (age, sex, race, educational level, marital status, yearly household income), alopecia diagnosis (CCCA, TA, AGA, FFA, LPP), and adherence factors (duration of topical minoxidil use, perceptions of treatment efficacy, rationale for discontinuing therapy if applicable). The outcome variable was adherence. Adherence as a dichotomous variable was based on whether patients reported current minoxidil use (adherent) or previous minoxidil use (non-adherent). Additionally, level of adherence was assessed in adherent patients based on the MGL scale score (low, medium, or high).
