Combined Low Dose Oral Minoxidil and Immunomodulator Efficacy and Safety in Alopecia Areata: A Systematic Review

    December 2025 in “ International Journal of Dermatology ”
    Eric McMullen, Sana Gupta, Michelle Pham, Daniel Rayner, Cathryn Sibbald, Jeffrey Donovan, Arash Mostaghimi
    TLDR Combining low-dose oral minoxidil with immunomodulators shows promise for treating alopecia areata but needs more research.
    This systematic review evaluated the efficacy and safety of combining low-dose oral minoxidil (LDOM) with systemic immunomodulators, particularly Janus kinase inhibitors (JAKis), in treating alopecia areata (AA). The review included 19 studies with 388 patients, predominantly using oral tofacitinib and baricitinib. Results showed that 71.4% of patients achieved a SALT score ≤ 20 with combination therapy, significantly higher than monotherapy outcomes. However, adverse events such as hypercholesterolemia and hypertrichosis were noted. Despite promising results, the evidence is limited by small sample sizes and potential biases, highlighting the need for larger, randomized controlled trials to better assess the efficacy and safety of this combination therapy.
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