Several reports discuss the use of topical minoxidil for alopecia areata1-16 with reported cosmetic efficacy varying from 0%8,15 to 53%.2 These results reflect wide variability in study design as well as in drug formulation and concentration. Proper formulation of minoxidil is critical because of its poor solubility in most vehicles17 and because of its limited bioavailability (1% to 4%).18 In view of the poor percutaneous absorption of minoxidil, studies utilizing extemporaneous formulations2-5,7,9 or concentrations less than 5% are difficult to interpret.1-9,11,12,15,16Dr Epstein is critical of the minoxidil references cited in table 1 because they included three references by our group and one by Price. These references contain the essential body of data on placebo-controlled cosmetic efficacy studies of 5% minoxidil in severe alopecia areata. He is critical of reference 4114 for having no controls. This is a summary reference of references 426 and 3910 and
Fiedler VC. Alopecia Areata, Topical Minoxidil, and Balanced Reviews-Reply. Arch Dermatol. 1993;129(7):909. doi:10.1001/archderm.1993.01680280099025
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