Rogaine - Does it work on the front hairline?

The short answer is - YES!!!

Minoxidil is a topical medication that is FDA approved for treating genetic hair loss (sometimes referred to as androgenetic alopecia). If you look at a bottle of minoxidil it will state that it is to be used for hair loss in the crown in men and may not benefit other areas of hair loss. The original studies of minoxidil focused on the crown and did not address the benefit in the front of the scalp.

Many hair loss specialists around the world have witnessed benefit to minoxidil in the front of the scalp in balding men. However, the companies which produce minoxidil are not setting out to formally prove the benefit in the front of the scalp and are not seeking approval from health regulatory authorities to be able to change the labelling on the bottles to indicate that it "works in the front and back."

In the past year there have now been two good studies showing what we've known for a long time - that minoxidil helps hair loss in the front of the scalp too!

A large study from Germany provided confirmation that minoxidil indeed benefits the frontotemporal scalp in men with AGA.

The investigators assessed the efficacy of twice daily 5% minoxidil foam in the frontotemporal region of male AGA patients after 24 weeks of treatment compared to placebo treatment and to the vertex region. Changes in target non-vellus hair count were the primary end point. Secondary endpoints included changes in hair width as well as clinician and patient ratings of improvement.

Study results showed that hair counts and width increased significantly compared to baseline in both the frontotemporal and vertex scalp. Furthermore, study subjects using 5% minoxidil foam rated a significant improvement in scalp coverage for both the frontotemporal (p = 0.016) and vertex areas (p = 0.027). Clinician assessors, however, were only able to appreciate a difference in the crown and not in the frontotemporal scalp.

In another smaller study, Mirmirani et al performed a double-blinded, placebo controlled study of minoxidil topical foam 5% (MTF) vs placebo in sixteen healthy men ages 18-49 with Hamilton-Norwood type IV-V AGA. Study participants applied treatment (active drug or placebo) to the scalp twice daily for eight weeks. Scalp photographs were taken at the baseline and final visits to monitor hair growth. Furthermore, scalp biopsies were assessed for changes in gene expression via microarray analysis.

Results showed that minoxidil improved frontal and vertex scalp hair growth of AGA patients and induced changes in target gene expression in both regions of the scalp.

Conclusion:

Minoxidil has long been understood to benefit men with hair loss in the crown. Good evidence shows it also benefits men with hair loss in the front (temples).

Reference

Hillman K, Bartels GN, Stroux A, Canfield D, and Blume-Peytavi U. Investigator-initiated double blind, two-armed, placebo-controlled, randomized clinical trial with an open -label extension phase, to investigate efficacy of 5 % Minoxidil topical foam twice daily in men with androgenetic alopecia in the fronto-temporal and vertex region concerning hair volume over 24/52 weeks. Poster at: World Congress of Hair Research, Edinburgh Scotland May 2013

Hillman K et al. A Single-Centre, Randomized, Double-Blind, Placebo-Controlled Clinical Trial to Investigate the Efficacy and Safety of Minoxidil Topical Foam in Frontotemporal and Vertex Androgenetic Alopecia in Men. Skin Pharmacol Physiol. 2015;28:236-244.

Mirmirani et al. Similar Response Patterns to 5%Topical Minoxidil Foam in Frontal and Vertex Scalp of Men with Androgenetic Alopecia: A Microarray Analysis. Br J Dermatol. 2014 Sep 10.