Minoxidil is probably best known as a topical medication applied to the scalp to encourage hair growth. Low-dose oral minoxidil uses the same medication in pill or liquid form for oral intake. 

For people with alopecia areata, there is an important distinction: 

• Minoxidil can help promote hair growth, but it does not treat the underlying autoimmune disease that causes alopecia areata. 

• Because of this, a healthcare provider may consider oral minoxidil as an add-on treatment alongside medications that target AA itself. The expert panel supported combining LDOM with other systemic treatments when appropriate, including JAK inhibitors and corticosteroids.  

• In combination with other medications treating the underlying AA: It can be an adjunct to therapies such as JAK inhibitors and corticosteroids that address the immune activity involved in alopecia areata. 

• To support hair growth: Low-dose oral minoxidil may be added to help encourage hair growth. 

The consensus identified several situations in which oral minoxidil may be considered. Applying topical minoxidil every day can be logistically difficult for some children and families, particularly when hair loss is widespread. Other considerations may include scalp irritation, unwanted residue or changes in hair texture from topical minoxidil, sensory sensitivities, inadequate results with topical treatment, caregiver preference, or concerns about accidental exposure of household pets to topical minoxidil.  

 The choice between topical and oral minoxidil should be individualized for each child. 

The consensus recommendations provide clinicians with a framework for deciding which children may be appropriate candidates and when additional screening or consultation may be needed. 

A child’s healthcare provider should review their medical history, current medications and any cardiovascular or other health concerns before prescribing LDOM. Certain medical conditions may make oral minoxidil inappropriate or require additional evaluation.  

For otherwise healthy children without identified risk factors, the experts did not recommend extensive testing or specialist consultation for every child. Decisions about testing and monitoring should be individualized. 

One of the most common side effects of oral minoxidil is hypertrichosis, or increased hair growth on areas of the body other than the scalp. 

The consensus also recommends that families be advised about symptoms that should be discussed with their child’s healthcare provider, including dizziness or lightheadedness, a fast or unusual heartbeat, swelling of the feet or legs, headache, facial swelling, unexpected weight gain or signs of an allergic reaction.  

Hair growth takes time. The experts agreed that visible improvement generally should not be expected before about three months, with improvement most commonly seen within 3 to 12 months. For chronic hair disorders, oral minoxidil may be used longer term. Hair gained or maintained with minoxidil may be lost if the medication is discontinued.  

These recommendations are based on the collective experience and agreement of experts who treat pediatric hair disorders. They are not the same as evidence from a clinical trial. 

There have not yet been randomized clinical trials establishing the effectiveness or long-term safety of low-dose oral minoxidil in children younger than 12 years. More research is needed to understand its effectiveness, optimal dosing and long-term safety in children.  

 The experts also did not reach consensus about using LDOM in children younger than 4 years of age.  

• • What role would oral minoxidil play in my child’s overall AA treatment plan? 
  • Why are you recommending oral rather than topical minoxidil (or vice versa)? 
  • What side effects should we watch for? 
  • Does my child need any testing before starting treatment? 
  • How will we know whether the treatment is working?
  • How long might my child need to take it?