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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Woman &#40;aged 33 years&#41; with female pattern hair loss before starting oral minoxidil treatment &#40;1&#160;mg&#47;d&#41;&#46; B&#44; Patient after 12 months of treatment&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Oral minoxidil &#40;2&#44;4-diamino-6-piperidinopyrimidine-3-oxide&#41; is a potent peripheral vasodilator that was initially used in the 1970s for the treatment of severe refractory hypertension at doses of 10&#160;mg&#47;day to 100&#160;mg&#47;day&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Owing to the development of hypertrichosis in a quarter of the patients who received this drug&#44; a topical formulation was developed to treat pattern hair loss&#44; first in men and subsequently in women&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The mechanism of action of minoxidil on the hair follicle is poorly understood&#46; Through the action of its active form&#44; minoxidil sulfate&#44; topical minoxidil shortens the telogen phase and causes resting follicles to prematurely enter the anagen phase&#46; It also prolongs the anagen phase and increases hair follicle size&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Oral administration reduces blood pressure by inducing relaxation of vascular smooth muscle through the opening of sarcolemmal ATP2-dependent potassium channels&#46; Minoxidil&#39;s effect on the hair follicle is also thought to be mediated by minoxidil sulfate-induced opening of potassium channels&#44; although this remains to be demonstrated &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Due to the adverse effects observed at standard doses&#44; oral minoxidil is not widely used for the treatment of alopecia&#46; Evidence indicates that oral minoxidil at low doses &#40;0&#46;5&#8211;2&#46;5&#160;mg&#47;d&#41; is beneficial in the treatment of isolated cases of permanent alopecia caused by chemotherapy&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> chronic telogen effluvium&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> female pattern hair loss&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and monilethrix&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> In our experience&#44; oral minoxidil is a particularly interesting option for the treatment of female pattern hair loss and chronic telogen effluvium &#40;1&#160;mg&#47;d&#41; and male pattern hair loss &#40;5&#160;mg&#47;d&#41;&#46; It can be administered as monotherapy or in combination with a low-intensity topical minoxidil regimen &#40;e&#46;g&#46; 3 days per week&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The main adverse effect is facial hypertrichosis&#44; the risk of which is dose-dependent &#40;4&#37; risk at 0&#46;25&#160;mg&#47;d&#44; 38&#37; risk at 1&#160;mg&#47;d&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a> This adverse effect is reversible upon discontinuation of treatment&#44; and in our experience is generally mild and does not pose a significant problem for the patient&#46; Isolated cases &#40;&#60;2&#37; of patients&#41; of postural hypotension and tachycardia have also been reported&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and therefore measurement of baseline blood pressure is recommended&#46; In patients with blood pressure values &#60;90&#47;60&#160;mmHg and those with postural hypotension &#160;sodium chloride &#40;50 mg&#41; should be added to the formulation&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> In our professional experience doses of 1&#160;mg&#47;day are safe and rarely cause hypotension&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In Spain&#44; oral minoxidil is sold as 10-mg tablets for the treatment of severe arterial hypertension&#44; but it can be formulated in capsules&#46; In patients with female pattern hair loss the addition of spironolactone &#40;25&#160;mg&#41; reduces the risk of edema in the lower limbs and potentiates the therapeutic effects of minoxidil&#44; although theoretically spironolactone can worsen postural hypotension&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion&#44; oral minoxidil at low doses is an interesting therapeutic alternative in patients who decline or do not tolerate topical administration&#44; especially in cases of female pattern hair loss&#46;</p></span>"
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Resident's Forum
RF – Oral Minoxidil for Female Pattern Hair Loss and Other Alopecias
FR – Minoxidil oral para el tratamiento de la alopecia androgénica femenina y otras alopecias
C. Pindado-Ortega
Autor para correspondencia
cpindadoortega@gmail.com

Corresponding author.
, D. Saceda-Corralo, S. Vañó-Galván
Servicio de Dermatología, Hospital Ramón y Cajal, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Oral minoxidil &#40;2&#44;4-diamino-6-piperidinopyrimidine-3-oxide&#41; is a potent peripheral vasodilator that was initially used in the 1970s for the treatment of severe refractory hypertension at doses of 10&#160;mg&#47;day to 100&#160;mg&#47;day&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Owing to the development of hypertrichosis in a quarter of the patients who received this drug&#44; a topical formulation was developed to treat pattern hair loss&#44; first in men and subsequently in women&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The mechanism of action of minoxidil on the hair follicle is poorly understood&#46; Through the action of its active form&#44; minoxidil sulfate&#44; topical minoxidil shortens the telogen phase and causes resting follicles to prematurely enter the anagen phase&#46; It also prolongs the anagen phase and increases hair follicle size&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Oral administration reduces blood pressure by inducing relaxation of vascular smooth muscle through the opening of sarcolemmal ATP2-dependent potassium channels&#46; Minoxidil&#39;s effect on the hair follicle is also thought to be mediated by minoxidil sulfate-induced opening of potassium channels&#44; although this remains to be demonstrated &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Due to the adverse effects observed at standard doses&#44; oral minoxidil is not widely used for the treatment of alopecia&#46; Evidence indicates that oral minoxidil at low doses &#40;0&#46;5&#8211;2&#46;5&#160;mg&#47;d&#41; is beneficial in the treatment of isolated cases of permanent alopecia caused by chemotherapy&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> chronic telogen effluvium&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> female pattern hair loss&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and monilethrix&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> In our experience&#44; oral minoxidil is a particularly interesting option for the treatment of female pattern hair loss and chronic telogen effluvium &#40;1&#160;mg&#47;d&#41; and male pattern hair loss &#40;5&#160;mg&#47;d&#41;&#46; It can be administered as monotherapy or in combination with a low-intensity topical minoxidil regimen &#40;e&#46;g&#46; 3 days per week&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The main adverse effect is facial hypertrichosis&#44; the risk of which is dose-dependent &#40;4&#37; risk at 0&#46;25&#160;mg&#47;d&#44; 38&#37; risk at 1&#160;mg&#47;d&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a> This adverse effect is reversible upon discontinuation of treatment&#44; and in our experience is generally mild and does not pose a significant problem for the patient&#46; Isolated cases &#40;&#60;2&#37; of patients&#41; of postural hypotension and tachycardia have also been reported&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and therefore measurement of baseline blood pressure is recommended&#46; In patients with blood pressure values &#60;90&#47;60&#160;mmHg and those with postural hypotension &#160;sodium chloride &#40;50 mg&#41; should be added to the formulation&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> In our professional experience doses of 1&#160;mg&#47;day are safe and rarely cause hypotension&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In Spain&#44; oral minoxidil is sold as 10-mg tablets for the treatment of severe arterial hypertension&#44; but it can be formulated in capsules&#46; In patients with female pattern hair loss the addition of spironolactone &#40;25&#160;mg&#41; reduces the risk of edema in the lower limbs and potentiates the therapeutic effects of minoxidil&#44; although theoretically spironolactone can worsen postural hypotension&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion&#44; oral minoxidil at low doses is an interesting therapeutic alternative in patients who decline or do not tolerate topical administration&#44; especially in cases of female pattern hair loss&#46;</p></span>"
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