Are higher does of Minoxidil more effective?

[Bryan]

Retinoids, like Retin-A, basically remove the keratinized layer of cells from the epithelium of the skin improving absorption of drugs like Minoxidil through the stratified squamous layer. It is possible that Retin-A could penetrate deep enough to cause tissue remodeling, but I don't believe that has been proven.

Keep in mind the study showing growth from Retin-A alone. It evidently does more than just increase the absorption of drugs like minoxidil.

Bryan

 

[joseph49853]

I even see some people applying minxodil well before the actual vehicle of absorption, Retin-a -- for whatever reason.

What do you think is wrong with THAT?

Bryan

I'm not saying it's wrong as much as it's less likely effective. Something like propolyne glycol has been proven not to degrade, so it's added directly to the mixture. You certainly wouldn't apply it well after minoxidil and expect similar results.

Although, I can't prove Retin-a degrades a minoxidil mixture with 100 percent veracity, just as it's currently difficult to prove otherwise. But I would rather err on the side of caution. Maybe the overall results will even speak for themselves.

 

[Bryan]

I'm not saying it's wrong as much as it's less likely effective.

Yeah, I gathered that that's what you think. What I'm asking you is WHY do you think it's less effective?

Bryan

 

[Strat54]

http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202574.html

Other medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur....... When you are using topical tretinoin, it is especially important that your health care professional know if you are taking any of the following:
-Acitretin (e.g., Soriatane)
-Etretinate (e.g., Tegison)
-Tretinoin, oral (e.g., Vesanoid)—May increase chance of getting severe dryness or redness of skin

Precautions While Using This Medicine
You should avoid washing the skin treated with tretinoin for at least 1 hour after applying it.

Avoid using any topical medicine on the same area within 1 hour before or after using tretinoin. Otherwise, tretinoin may not work properly or skin irritation might occur.

 

[joseph49853]

http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202574.html

Other medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur....... When you are using topical tretinoin, it is especially important that your health care professional know if you are taking any of the following:
-Acitretin (e.g., Soriatane)
-Etretinate (e.g., Tegison)
-Tretinoin, oral (e.g., Vesanoid)—May increase chance of getting severe dryness or redness of skin

Precautions While Using This Medicine
You should avoid washing the skin treated with tretinoin for at least 1 hour after applying it.

Avoid using any topical medicine on the same area within 1 hour before or after using tretinoin. Otherwise, tretinoin may not work properly or skin irritation might occur.

Thanks strat. I appreciate it. And this reflects my experiences as well. Except I've started to wait only 30 minutes. And I've found that the irritation has lessened over the past six months.

But with Retin-a, you never know how much irritation sometimes until it's too late. In this case, a conservative approach might be the best method. Or this is what I'm advocating.

 

[Strat54]

There are many sites with Retin-A general information and usage guidelines.
I also started by waiting 30 minutes to apply minoxidil after Retin-A for many months, and then started to wait 1 hour.

But I think minoxidil worked pretty well by applying 30 minutes after Retin-A.

 

[LookingGood!]

I beginning to think it doesnt matter if you separate the 2. I really think it's on an individual's preference. The stories are anecdotal at best and that's ok. I dont buy into the conspiracy theory that MDs have an agenda. People have grown hair with the combo and separating the 2 also. Personally I cant wait 30 minutes to 1 hr to do this, especially in the AM.

Dr lee said in a recent email he is losing faith in retin A with minoxidil 5% because the absorption of 5% is clearly substantial and the retin A is basically useless. It may cause irritation on fairly skinned people.
He told me to use just the 5% instead of it. I am off the Xandrox 5% b/c I hate the way azelaic acid makes my hair look and feel.
Moreover, I think people who separate it may be under the influence of established posters who say that's what you should do. So my point is who do I believe, Bryan and Co who have honorable intentions or Dr Lee?

I guess we just have to experiment with what's best. Since we all are unsure of how minoxidil really works to grow hair its basically up to the individual to apply it as he sees fit.

 

[Bryan]

There are many sites with Retin-A general information and usage guidelines.
I also started by waiting 30 minutes to apply minoxidil after Retin-A for many months, and then started to wait 1 hour.

But I think minoxidil worked pretty well by applying 30 minutes after Retin-A.

It doesn't make any difference how long you wait (I'm talking about efficacy for growing hair).

And I'm still waiting for Joseph's answer.

Bryan

 

[IDOASIS]

Heh. Long-time posters here know that I'm not a big fan of azelaic acid. There's only one in vitro study showing it to be a 5a-reductase inhibitor, but there's not even one single study showing it to do that in vivo. Not so much as one lousy human study, not even a mouse, rat, or hamster study. I'm skeptical.

Bryan

Well ,there is one "lousy human study" in vivo.

Comparison of azelaic acid and anthralin for the therapy of patchy alopecia areata: a pilot study.Sasmaz S, Arican O.
Department of Dermatology, School of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey. sezaisamaz@hotmail.com

BACKGROUND: Although topical azelaic acid has been previously used for the treatment of alopecia, no controlled trials of azelaic acid for this condition have been conducted to date. OBJECTIVE: The goal of this study was to determine the efficacy, tolerability, and safety of azelaic acid treatment in patients with patchy alopecia areata (AA) in comparison with anthralin (dithranol) treatment. SUBJECTS AND METHODS: This study included 31 subjects with patchy AA who did not receive any treatment for at least 1 month prior to the study. Demographic and clinical characteristics of these subjects were recorded at baseline. Subjects were randomized to apply either 20% azelaic acid (15 subjects) or 0.5% anthralin (16 subjects) for 12 consecutive weeks. In a subsequent 8-week follow-up period no cream was applied. Two independent investigators performed an efficacy evaluation with clinical examination using a terminal hair regrowth score (RGS) with a scale ranging from 0 (inadequate response) to 2 (complete response) at week 20. Partial response was accepted as score 1. RESULTS: Both groups were well matched for the relevant demographic and clinical indicators affecting treatment response at baseline. All subjects completed the trial. At week 20 the RGS was 1.27 +/- 0.9 in the azelaic acid group versus 1.37 +/- 0.8 in the anthralin group (p > 0.05). A complete response was observed in 53.3% of cases in the azelaic acid group (8 of 15) compared with 56.2% (9 of 16) in the anthralin group (p > 0.05). No serious adverse events were observed in either group during the study. CONCLUSION: The present pilot study showed that the use of azelaic acid gave similar results to anthralin with regard to hair regrowth, and that it can be an effective topical therapy for patchy AA. More extensive trials are necessary, however, to reach a definitive conclusion.

 

[docj077]

Heh. Long-time posters here know that I'm not a big fan of azelaic acid. There's only one in vitro study showing it to be a 5a-reductase inhibitor, but there's not even one single study showing it to do that in vivo. Not so much as one lousy human study, not even a mouse, rat, or hamster study. I'm skeptical.

Bryan

Well ,there is one "lousy human study" in vivo.

Comparison of azelaic acid and anthralin for the therapy of patchy alopecia areata: a pilot study.Sasmaz S, Arican O.
Department of Dermatology, School of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey. sezaisamaz@hotmail.com

BACKGROUND: Although topical azelaic acid has been previously used for the treatment of alopecia, no controlled trials of azelaic acid for this condition have been conducted to date. OBJECTIVE: The goal of this study was to determine the efficacy, tolerability, and safety of azelaic acid treatment in patients with patchy alopecia areata (AA) in comparison with anthralin (dithranol) treatment. SUBJECTS AND METHODS: This study included 31 subjects with patchy AA who did not receive any treatment for at least 1 month prior to the study. Demographic and clinical characteristics of these subjects were recorded at baseline. Subjects were randomized to apply either 20% azelaic acid (15 subjects) or 0.5% anthralin (16 subjects) for 12 consecutive weeks. In a subsequent 8-week follow-up period no cream was applied. Two independent investigators performed an efficacy evaluation with clinical examination using a terminal hair regrowth score (RGS) with a scale ranging from 0 (inadequate response) to 2 (complete response) at week 20. Partial response was accepted as score 1. RESULTS: Both groups were well matched for the relevant demographic and clinical indicators affecting treatment response at baseline. All subjects completed the trial. At week 20 the RGS was 1.27 +/- 0.9 in the azelaic acid group versus 1.37 +/- 0.8 in the anthralin group (p > 0.05). A complete response was observed in 53.3% of cases in the azelaic acid group (8 of 15) compared with 56.2% (9 of 16) in the anthralin group (p > 0.05). No serious adverse events were observed in either group during the study. CONCLUSION: The present pilot study showed that the use of azelaic acid gave similar results to anthralin with regard to hair regrowth, and that it can be an effective topical therapy for patchy AA. More extensive trials are necessary, however, to reach a definitive conclusion.

Different disease and different mechanism of action from what Bryan is talking about. AA is different from androgenic alopecia that their treatments are quite different.

This drug may grow hair in people with AA, but a study is needed that demonstrates its effectiveness in people with male pattern baldness.

 

[Bryan]

Well ,there is one "lousy human study" in vivo.

Hey Junior, clean your glasses carefully, then go back and re-read what I said previously. Here it is again for your convenience:

There's only one in vitro study showing it to be a 5a-reductase inhibitor, but there's not even one single study showing it to do that in vivo.

Capiche?

Bryan

 

[joseph49853]

There are many sites with Retin-A general information and usage guidelines.
I also started by waiting 30 minutes to apply minoxidil after Retin-A for many months, and then started to wait 1 hour.

But I think minoxidil worked pretty well by applying 30 minutes after Retin-A.

It doesn't make any difference how long you wait (I'm talking about efficacy for growing hair).

And I'm still waiting for Joseph's answer.

Bryan

You speak so definitively. But can you scientifically prove, or cite studies, stating that efficacy isn't changed by any percentage? No. Can I prove anything to the contrary? No. So I'm not even sure what the point is to arguing.

Nothing personal Bryan, but I didn't come here to answer directly to you. If you were even asking anything other than rhetorical questions, I might even give an answer.

However, I am here to share some of my own knowledge and practical experience. Just as: feel free to dispense whatever advice you choose. Maybe we might even be here for the same reason, even if that's currently in doubt, at least for me.

 

[Bryan]

You speak so definitively. But can you scientifically prove, or cite studies, stating that efficacy isn't changed by any percentage? No.

Don't you think it's pretty obvious when you think about it carefully?

Can I prove anything to the contrary? No. So I'm not even sure what the point is to arguing.

I asked you that question to find out for sure exactly what you believe about that issue, and why.

Nothing personal Bryan, but I didn't come here to answer directly to you. If you were even asking anything other than rhetorical questions, I might even give an answer.

It wasn't a rhetorical question. I was deadly serious in asking you for your opinion on that matter.

Bryan

 

[IDOASIS]

This drug may grow hair in people with AA, but a study is needed that demonstrates its effectiveness in people with male pattern baldness.

As I recall its quite the same.

Baldness is a trait which involves the state of lacking hair where it often grows, especially on the head. The most common form of baldness is a progressive hair thinning condition called androgenic alopecia or 'male pattern baldness' that occurs in adult human males and some primate species

Male pattern baldness is characterized by hair receding from the lateral sides of the forehead, known as "receding hairline" or "receding brow." An additional bald patch may develop on top (vertex). The trigger for this type of baldness (called androgenic alopecia because it is caused by male hormones or androgens) is DHT, a powerful sex hormone

Well ,there is one "lousy human study" in vivo.

Hey Junior, clean your glasses carefully, then go back and re-read what I said previously. Here it is again for your convenience:

There's only one in vitro study showing it to be a 5a-reductase inhibitor, but there's not even one single study showing it to do that in vivo.

Capiche?

Bryan

No need to get all exited ,I was joking .
This study suggests Azelaic Acid might be effective.
I dont think it inhibits 98% of the DHT ,
but it is more effective than you think.

 

[powersam]

is that the rumble of a slap down approaching i hear on the wind?

 

[Bryan]

This drug may grow hair in people with AA, but a study is needed that demonstrates its effectiveness in people with male pattern baldness.

As I recall its quite the same.

WHAT is quite the same? What do you mean?

No need to get all exited ,I was joking .
This study suggests Azelaic Acid might be effective.
I dont think it inhibits 98% of the DHT ,
but it is more effective than you think.

More effective than I think for WHAT? Why are you speaking in riddles?

There are several studies showing the effectiveness of azelaic acid for acne, and now there's one suggesting an effectiveness for alopecia areata. But we aren't talking about acne or alopecia areata, we're talking about alopecia androgenetica, and whether or not azelaic acid can inhibit 5a-reductase when applied topically. There's not one whit of published scientific evidence for either one of those. Why don't we stick to the subject(s) at hand?

Bryan

 

[docj077]

This drug may grow hair in people with AA, but a study is needed that demonstrates its effectiveness in people with male pattern baldness.

As I recall its quite the same.

Then, you're recalling quite incorrectly. Alopecia Areata and Androgenic Alopecia are two very different phenomenon caused by two very different processes.

Alopecia areata is considered to be an autoimmune disorder and androgenic alopecia is a hormonally-linked disease that results in fibrotic response. They are not similiar in any way except for that they cause a similar result.

You have much to learn young padawan.

 

[IDOASIS]

You have much to learn young padawan.

You are quite an arrogant ha?

Alopecia areata is considered to be an autoimmune disorder and androgenic alopecia is a hormonally-linked disease that results in fibrotic response. They are not similiar in any way except for that they cause a similar result.

How do you think male pattern baldness occurs?
The immune system has a role in it.

By yet unknown mechanisms, DHT causes a change in the follicle
signaling the immune system to attack the follicle and your
hair starts falling out (If you take a close look, you can
actually see a red line of inflammation on the scalp of
some people losing their hair). How do we know this? It
was discovered that the hair follicles of people losing
their hair look very similar under a microscope to people
who experience organ rejection after surgery. And, it has
been found that the immune system suppressing drug which
is used to stop the organ rejection (Cyclosporine) grows
hair like crazy because it shuts down the immune response
in the body

So if it can inhibit the immune system to attack the follicle ,it
can be effective in male pattern baldness.
It sure grew back my hairline.

 

[docj077]

You have much to learn young padawan.

You are quite an arrogant ha?

Alopecia areata is considered to be an autoimmune disorder and androgenic alopecia is a hormonally-linked disease that results in fibrotic response. They are not similiar in any way except for that they cause a similar result.

How do you think male pattern baldness occurs?
The immune system has a role in it.

By yet unknown mechanisms, DHT causes a change in the follicle
signaling the immune system to attack the follicle and your
hair starts falling out (If you take a close look, you can
actually see a red line of inflammation on the scalp of
some people losing their hair). How do we know this? It
was discovered that the hair follicles of people losing
their hair look very similar under a microscope to people
who experience organ rejection after surgery. And, it has
been found that the immune system suppressing drug which
is used to stop the organ rejection (Cyclosporine) grows
hair like crazy because it shuts down the immune response
in the body

So if it can inhibit the immune system to attack the follicle ,it
can be effective in male pattern baldness.
It sure grew back my hairline.

I do not think you understand the nature of male pattern baldness. TGF-beta may be an immune regulatory molecule, but that does not mean that every person has immune response during male pattern baldness. Not every person has infiltrates of lymphocytes and leukocytes to the area of the follicle. Alopecia areata has this response, because the body begins to recognize the hair follicle itself as foreign with an all out race to destroy the hair follicle being employed by both the innate and specific sides of the immune system doing the damage.

In male pattern baldness, TGF-beta is upregulated causing the activation of fibroblasts, which deposit collagen around the follicle and cause perifollicular fibrosis. No immune response is required and an immune response is rarely seen unless the it's secondary to bacteria breaking down secretions from the sebaceous glands into proinflammatory fatty acids. This doesn't happen in every person, so there isn't an immune response.

If you think that there is an immune response, then it's your job to show that 100% of men with male pattern baldness have antibodies to the cells that make up their own hair follicles and that 100% of men with male pattern baldness have immune cell infiltrates around all follicles demonstrating miniaturization.

Cyclosporine regrows hair through mediation of a particular molecular pathway, which I will leave up to you to discover...the reason is somewhere on these forums, but I don't feel like looking for it right now. Topical steriods that cause hair regrowth do so by removing an inflammatory responses that are occurring secondary to androgenic stimulation of the sebacous glands. That's why that treatment does not work for every person.

DHT's role in the inhibition of hair growth is not a mystery. DHT binds to the androgen receptor, which is a nuclear receptor. It does so in the cytoplasm of the target cell and moves into the nucleus to act as a transcription factor. While there it seems to upregulate the expression of TGF-beta, which is the cytokine responsible for collagen deposition and fibrosis.

TGF-beta is the same molecule that causes fibrosis of the kidneys, liver, lungs, and even the heart after they are damaged and removal of this molecule during experimentation has demonstrated that the fibrosis will clear itself once the pro-fibrotic nature of TGF-beta is removed from whatever tissue it's influencing.

 

[LookingGood!]

I think Doctor explained the differences of the 2 types of hair disorders quite well so lets try to stay on topic and move on.

As for half life of minoxidil, what is the 1/2 life for 2%, 5% and 15%

Correct me if I am wrong but the longer the 1/2 life the longer it is utilized systemically, so then we have to apply less of the drug? Moreover, 2% would have the lowest 1/2 life then we would have to apply it 2 -3 times a day, 5% 1-2 times a day and 15% 1 time a day????

Some assistance please.