Picture this: you just got prescribed Minoxidil to relieve your hair loss problems. But then instead of regrowing your hair, it SHEDS! In this article we'll find out what, why and how does minoxidil shedding work? Of course, there's also solutions to this!
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What Is Hair And Why Does It Shed?
Hair is an integral part of human existence. Not only does hair reflects an individual's personality but also boosts confidence. Hair grows from the hair follicles located in the outermost layer of the skin, the epidermis, with an average rate of half an inch each month.
Approximately 100,000 hair follicles are present on a human scalp accompanied by the sebaceous glands. Hair derives nourishment from the vessels near the hair follicles and the oily secretions of the sebaceous gland. Losing 50-100 hair strands daily is normal for a healthy individual. Different conditions associated with hair loss affect the hair follicles and the hair growth pattern and growth rate.
Androgenetic alopecia or male pattern baldness is one of the most common hair conditions that affects a significant percentage of both men and women. The hormonal imbalance associated with this disorder disrupts the hair growth cycle which eventually reduces hair growth and causes the hair to fall off.
Another common hair condition that causes hair loss is telogen effluvium. Stressful events such as surgery, trauma, pregnancy, childbirth, and mental stress disturb the natural balance of the hair growth cycle that leads to premature hair fall.
Hair loss is more prevalent among men and increases with the increase in age. Women also suffer from visible hair loss that peaks at the age of 40. Several oral and topical medications have been derived to treat and reverse hair loss. Hair loss treatment gives back the lost confidence to the affected individual and restores the self-image.
Introduction of Minoxidil
Minoxidil, sold under the brand name Rogaine, is approved by the US Food and Drug Administration (FDA) for treating hair loss. In 1970, minoxidil was initially used to treat hypertension owing to its vasodilating abilities.
Later on, with the discovery of hair regrowth in individuals treated with oral minoxidil, topical minoxidil was formulated to treat hair loss problems among men and women. Topical minoxidil in the form of foam, 2%, and 5% solution is used to treat individuals suffering from androgenetic alopecia and other forms of hair loss disorders.
Minoxidil foam is prioritized over minoxidil solution with the same concentration due to effective delivery, reduced scalp irritation, and the ability to dry quickly after application.
Minoxidil is an over-the-counter drug that is easily available online and at different pharmacies all over the country. However, a doctor shall be consulted in order to discuss the current health status and drug interactions if a person is consuming any drugs alongside minoxidil.
Minoxidil acts on the hair follicles to exert its growth-promoting effects, with the hair growth rate peaking at one year of minoxidil use. Aside from androgenetic alopecia, minoxidil is also used to treat alopecia areata with autoimmune basis, telogen effluvium, and chemotherapy-associated hair loss.
How Does Minoxidil Work?
Minoxidil sulfate is the active ingredient of minoxidil responsible for hair regrowth and reduced hair fall. Minoxidil is converted to minoxidil sulfate by an enzyme called sulfotransferase, present in the hair follicles. The genetics of an individual determine the activity of sulfotransferase and the effectiveness of minoxidil in treating hair loss. Drugs such as aspirin and salicylates inhibit the action of sulfotransferase resulting in hair loss despite using topical minoxidil.
The active metabolite of minoxidil works in different ways to reduce hair loss and promote the regrowth of hair. Minoxidil sulfate causes vasodilation of the vessels supplying the hair follicles and facilitates the delivery of nutrients and oxygen for healthy hair growth.
Minoxidil sulfate also promotes the secretion of prostaglandin E2 which stimulates cell proliferation in hair follicles and hair growth. This substance also enhances vascularity which provides nourishment to the hair follicles by opening the potassium channels. It also increases fenestrations or gaps between the vessel walls so that nutrients can easily reach the roots of growing hair.
What Is The Hair Growth Cycle?
Background knowledge of the hair growth cycle is essential for understanding how topical minoxidil works. The hair growth cycle can be divided into the following phases.
Anagen or growing phase is the longest phase of the hair growth cycle lasting for 3 to 7 years. Almost 90% of an individual's hair is in the anagen phase at a given time. The hair grows from the hair follicles as long as this phase lasts.
Catagen or transition phase is a very short phase with an average duration of 10 days. Approximately 5% of one's hair is in the catagen phase at a given time. During this phase, hair grows at a slower rate and the follicles shrink.
Telogen or resting phase has an average duration of 3 months and accounts for 10% to 15% of scalp hair. Neither does the hair grow nor do it fall off from the follicle during this phase.
While the previous three stages reflect the growth and maturation of the hair, the exogen or shedding phase is when the hair falls out. New hair grows and replaces the older hair loss during this phase, which lasts for 2 to 5 months.
In androgenetic alopecia, the excess androgens end the anagen phase and initiate the catagen phase prematurely. Minoxidil acts on the hair growth cycle by increasing the duration of the anagen or the growing phase of hair growth and shortening the telogen phase. This reduces hair fall, promotes regrowth of hair, and increases hair density.
What Is Minoxidil Shedding?
While using topical minoxidil, the majority of people complain about hair loss in the initial period. This is a famous side effect of using minoxidil, commonly known as minoxidil shedding. Hair loss or minoxidil shedding increases as the potency of the topical minoxidil increases.
Owing to this reason, 5% minoxidil solution or minoxidil foam causes an increase in hair loss, although it results in greater hair growth as compared to 2% minoxidil solution or foam. Minoxidil shedding may trigger anxiety among individuals who are new to the process, however, the phenomenon is temporary and resolves with time.
Minoxidil shedding is a normal mechanism and usually occurs in the first month of the hair loss treatment with topical minoxidil.
How Does Minoxidil Cause Shedding?
Minoxidil shedding or hair loss at the start of minoxidil treatment is a common side effect of topical minoxidil. The action of minoxidil sulfate on the telogen phase of the hair growth cycle is the prime reason for causing minoxidil shedding.
Minoxidil sulfate shortens the telogen phase and causes the hair strands to enter the exogen or shedding phase more quickly than usual. The causes the hair to spend lesser time in the resting phase and fall out from the follicles. However, under the action of minoxidil sulfate, the hair also enters the anagen phase faster than usual and results in accelerated hair growth.
This effect is visible when the new hair outnumbers the lost hair lost due to minoxidil shedding. An important benefit of minoxidil shedding is that the thinner and weaker hair is lost due to minoxidil use and paves the way for the growth of newer, healthier, and thicker hair. However, not every person who uses topical minoxidil experiences minoxidil shedding.
How Long Does Minoxidil Shedding Last?
Minoxidil shedding is prevalent in the initial phase of minoxidil treatment for hair loss. The onset of minoxidil shedding occurs at two to eight weeks after starting the minoxidil treatment. The minoxidil shedding lasts for four to six months, after which an individual observes visible improvement in hair growth as new and healthier hair in the anagen phase replace the weaker hair in the telogen phase of the hair growth cycle.
While minoxidil shedding can be worrisome for the majority of the users, it is a good sign nonetheless. This indicates that the treatment is working. Minoxidil shedding provides a kickstart to the journey of new hair growth.
Is Minoxidil Shedding Reversible?
One of the most famous concerns among people who opt for minoxidil treatment for hair loss is whether they'll recover the lost hair from minoxidil shedding or not. With the fear of losing all the hair on their scalp, many people tend to leave the hair loss treatment halfway.
But discontinuing the minoxidil treatment is not the solution and returns the hair to the pre-Minoxidil state. Acute telogen effluvium or minoxidil shedding is temporary and lasts for only three to four months. After this period, healthy thicker hair replaces the thinner hair and the hair loss also reduces significantly.
Minoxidil shedding can be reduced in a number of ways. A well-balanced diet rich in macronutrients, vitamins, and minerals including zinc, iron, niacin (vitamin B3), and biotin (vitamin B7) nourishes the hair follicles and enhance hair growth.
Therefore it is important to consume a healthy and balanced diet to reduce minoxidil shedding. Another important way to suppress minoxidil shedding is to avoid stress and anxiety. Stress hormones exaggerate minoxidil shedding by stimulating the premature telogen phase of the hair growth cycle. Stress can be a result of physical trauma, pregnancy, childbirth, medications, and impaired mental health.
Stress can also be a manifestation of minoxidil shedding. Hence, acute telogen effluvium or minoxidil shedding can be stopped by resolving stress, staying calm, and keeping one's mind at peace.
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How To Prevent Minoxidil Shedding?
Minoxidil shedding is inevitable and unpredictable in the majority of cases. Hair loss at the start of the minoxidil treatment occurs as minoxidil sulfate stimulates the weaker and thinner hair into the telogen phase of the hair growth cycle. This hair falls off and is replaced by thicker and stronger hair.
Without undergoing this shedding phase, people using minoxidil would not be able to grow new hair. Even though minoxidil shedding can't be avoided, the rate of hair loss can be controlled.
The rate of hair loss during minoxidil treatment is proportional to the concentration of topical minoxidil. 5% topical minoxidil foam and solution have higher potency and cause equally intense side effects that are higher hair shedding.
On the contrary, 2% topical minoxidil foam and solution are less potent and cause a lesser amount of hair fall. If an individual experiences significant hair loss upon minoxidil treatment, he or she should opt for a lower concentration of topical minoxidil and discontinue a more powerful dose of minoxidil. To prevent hair loss from the start, a person should initiate minoxidil treatment with 2% foam or solution.
When To See Your Doctor For Minoxidil Shedding?
Minoxidil shedding is a normal phenomenon in hair loss treatment. Hair loss caused by topical minoxidil can be tolerable to a certain extent. Severe hair loss can be an alarming sign of an underlying abnormality. This problem should be addressed immediately so as to prevent hair loss to an extent that can't be reversed.
If an individual faces hair loss beyond the time period of four to six months despite using topical minoxidil in moderation and low concentration, a healthcare expert should be approached soon. It is important to determine the underlying condition that is the cause of this excessive hair loss.
A person using topical minoxidil should approach the doctor for reasons other than severe hair loss. This includes a discharge from broken skin of the scalp. Use of topical minoxidil may also cause persistent irritation, scaly, and red skin. Sudden patchy hair loss which deviates from normal growth patterns is also a matter of concern and should be brought to a doctor's attention.
An individual should approach a therapist and receive counseling to relieve stress. Alleviating stress and anxiety are important to prevent excessive hair loss while using topical minoxidil.
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