Case and Research Letter
Morning Periorbital Edema Related to Low-Dose Oral Minoxidil
Edema periorbitario matutino por minoxidil oral a dosis bajas
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"apellidos" => "Mir-Bonafé" "email" => array:1 [ 0 => "joanmirbonafe@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Mir-Bonafé" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Rozas-Muñoz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "J.M." "apellidos" => "Mir-Bonafé" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Son Llàtzer, Palma de Mallorca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Tricología y Trasplante Capilar, Clínica Juaneda, Palma de Mallorca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Vital Álvarez Builla, Mieres, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital de San Pablo, Coquimbo, Chile" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Edema periorbitario matutino por minoxidil oral a dosis bajas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 761 "Ancho" => 1340 "Tamanyo" => 138744 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Periorbital edema in a 40-year-old man treated with oral minoxidil (5<span class="elsevierStyleHsp" style=""></span>mg/d). B, Periorbital edema in a 37-year-old woman treated with oral minoxidil (1<span class="elsevierStyleHsp" style=""></span>mg/d).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Over the last few years, the use of low-dose oral minoxidil to treat androgenetic alopecia has brought about a small revolution in the field of dermatology in general, and trichology in particular.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Oral administration appears to provide important benefits in terms of convenience, cosmesis, cost-efficiency, co-therapy, and compliance.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> However, although considered safe the use of this regimen requires an understanding of the drug and its adverse effects. The most frequently described adverse effects are hypertrichosis, postural hypotension, tachycardia, and pretibial edema.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Below, we describe 2 cases of morning periorbital edema associated with low doses of oral minoxidil, an effect rarely reported in the literature.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The first patient was a 40-year-old man with androgenetic alopecia (Hamilton–Norwood stage II) and no previous history of disease. He had received no previous treatment for his alopecia. The patient began treatment with oral minoxidil in monotherapy (5<span class="elsevierStyleHsp" style=""></span>mg/d), taken nightly. After 4 weeks of treatment, the patient noticed swelling of the lower eyelids in the morning (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). This swelling resolved spontaneously during the day, and had no impact on the patient's daily life, nor was it accompanied by edema in other locations or other clinical signs such as urticaria or respiratory distress. The patient was diagnosed with periorbital edema associated with oral minoxidil treatment. With the patient's consent, the dose of minoxidil was reduced to 3<span class="elsevierStyleHsp" style=""></span>mg/day, resulting in complete resolution of the symptoms within a few days.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The second patient was a 37-year-old woman with no previous history of disease who began treatment with oral minoxidil (1<span class="elsevierStyleHsp" style=""></span>mg/d, taken nightly) for androgenetic alopecia (Ludwig stage Ib). After 2 weeks of treatment, the patient reported the appearance of morning periorbital edema (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) that resolved spontaneously within 60<span class="elsevierStyleHsp" style=""></span>minutes. The edema was not accompanied by any additional clinical signs. It was decided to withdraw treatment for 12 weeks, resulting in complete resolution after 7 days. Treatment was subsequently reinitiated at a dose of 0.5<span class="elsevierStyleHsp" style=""></span>mg/day, taken nightly, without the reappearance of edema.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Edema associated with the use of oral minoxidil is widely documented in the literature.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–6</span></a> This effect is directly due to the drug's induction of capillary vasodilatation. The resulting edema most often affects the lower limbs, and develops in 1–10% of cases, depending on the dose used.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,5</span></a> Although it can occur in patients receiving doses as low as 1<span class="elsevierStyleHsp" style=""></span>mg/day, the risk is much higher in those treated with 5<span class="elsevierStyleHsp" style=""></span>mg/day.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> The likelihood of edema may be higher in obese patients and those receiving concomitant treatment with calcium channel blockers.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> It is not a serious adverse effect and does not result in long-term complications. It can even remit spontaneously after 2–3 months of treatment without the need to alter the dose regimen.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> In the most severe cases it can markedly impact quality of life, and may necessitate discontinuation of treatment.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> While edema in the lower limbs is a relatively common adverse effect, its appearance in other locations, such as the face, is unusual, accounting for around 0.3% of cases.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">While periorbital edema associated with low doses of oral minoxidil is very rare, we believe it is very important to be aware of this adverse effect. Its appearance in the morning is probably a result of prolonged decubitus, hence its spontaneous resolution during the day. In most of the cases described, and in the cases reported here, this effect is mild, and although dose reduction may be required, treatment discontinuation is not usually necessary. However, the location is very striking, and can give rise to confusion with allergic angioedema, which requires immediate attention. It is therefore important that patients are aware of this possible adverse effect and the accompanying warning signs.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 761 "Ancho" => 1340 "Tamanyo" => 138744 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Periorbital edema in a 40-year-old man treated with oral minoxidil (5<span class="elsevierStyleHsp" style=""></span>mg/d). B, Periorbital edema in a 37-year-old woman treated with oral minoxidil (1<span class="elsevierStyleHsp" style=""></span>mg/d).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of oral minoxidil for alopecia: systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I.J.B. do Nascimento" 1 => "M. Harries" 2 => "V.B. Rocha" 3 => "J.Y. Thompson" 4 => "C.H. Wong" 5 => "H.K. 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Rodrigues-Barata" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2021.02.054" "Revista" => array:6 [ "tituloSerie" => "J. Am. Acad. Dermatol." "fecha" => "2021" "volumen" => "84" "paginaInicial" => "1644" "paginaFinal" => "1651" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33639244" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety of oral minoxidil 5<span class="elsevierStyleHsp" style=""></span>mg once daily in the treatment of male patients with androgenetic alopecia: an open-label and global photographic assessment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Panchaprateep" 1 => "S. 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| año/Mes | Html | Total | |
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| 2024 Noviembre | 32 | 6 | 38 |
| 2024 Octubre | 499 | 123 | 622 |
| 2024 Septiembre | 511 | 106 | 617 |
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