Minoxidil (MNX), the first drug approved for androgenetic alopecia (AGA) in both genders by the US-FDA is most commonly prescribed as 2% or 5% minoxidil topical solution (MTS) for local scalp application. However, the cosmetic unacceptability and other local adverse effects including allergic contact dermatitis associated with the conventional alcoholic MTS often results in markedly reduced patient compliance. Although a patch test is essential to differentiate between allergic reaction to the solvents, namely ethanol and/or propylene glycol (PG) versus MNX molecule, the most common source of the allergic reactions and flaking of scalp with MTS is the alcoholic solvent vehicle. Alcohol-free MTS formulations have been launched but brands with tall claims need to be scrutinized before prescription. Shifting to the aerosolized foam preparation is one viable option, albeit a little costlier. Low dose oral MNX may be tried in patients recalcitrant to topical MNX or developing intolerable local adverse effects. Nanoxidil 5%, the new congener with a lower molecular weight and expectedly better penetration and tolerance may offer a leap over MNX but needs to be validated in large randomized controlled trials.

Keywords: Minoxidil topical solution; Androgenetic alopecia; Female pattern hair loss; Male pattern hair loss; Hair loss; Allergic contact dermatitis; Alcoholic solution; Propylene glycol; Patch Test; Minoxidil foam; Oral minoxidil; Nanoxidil