Use of Minoxidil Sulfate Versus Minoxidil Base in Androgenetic Alopecia Treatment: Friend or Foe?

The article discusses the use of minoxidil sulfate (MXS) versus minoxidil base (MX) in the treatment of androgenetic alopecia (AGA). MX is a pro-drug that needs to be converted to its activated metabolite MXS to act. Studies have shown that MXS is more effective than MX base, but its higher molecular weight and instability in aqueous solution may impair its bioavailability to the hair follicle and increase its irritation potential to the scalp. MX base remains the first-line topical agent for treatment of male and female AGA, unless the patient proves to be unresponsive, then a formulation of MXS at probably higher concentrations may present an alternative with enhanced efficacy. Comparative clinical trials and pharmacological studies with different formulations, either ready for use or custom made, with MX base or MXS, should be conducted in order to make final recommendations for optimal use in AGA treatment.