From Dr. Lee's website (xandrox.com)
MINOXIDIL with RETINOIC ACID
How and when to use it
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Topical all-trans-retinoic acid (aka tretinoin or retinoic acid or Retin-A) alone and in combination with minoxidil have been tested for the promotion of hair growth in patients with male pattern baldness. In an article in the Journal of the American Academy of Dermatology, there are cited several cases in which the use of retinoic acid alone prompted striking hair growth.
A 43 year old woman, who had extensive androgenetic alopecia since age 20, experienced a 1100% increase in hair counts over an 18 month period.
A male patient had previously received a series of hair transplants, but discontinued that treatment because of poor hair growth in the transplanted plugs. During the course of his treatment with retinoic acid, growth was initiated in the transplanted grafts and regular hair trimming was required.
There are postulated to be two mechanisms by which retinoic acid promotes hair growth in combination with minoxidil. Experimental evidence suggests that retinoic acid itself may play a significant role in hair growth and, because retinoic acid has been shown to increase percutaneous absorption (2,3), it is probable that the increased absorption caused by retinoic acid increases the amount of minoxidil reaching the hair follicle cells.
For the treatment of male pattern baldness, it is recommended that 1ml of 2% to 5% minoxidil topical solution be applied to the affected area twice a day. In the morning, 1ml of 2% to 5% minoxidil solution alone should be applied to the areas of the scalp with thinning hair. The nighttime application should contain 2% to 5% minoxidil with 0.025% retinoic acid
Overall, in subjects receiving retinoic acid in combination with minoxidil, positive responses were documented in 66%, with 44% placed in the good response group and 22% in the moderate response group. The five patients receiving placebo demonstrated no significant hair growth response.
With the initital use of retinoic acid on the scalp, a small percentage of patients experience an apparent increase in hair loss. The hair loss is more apparent than real and the same hair shaft replaces itself in about 3 months. But because the retinoic acid decreases the chemical bonding between the skin cells, hair that is in the telogen (resting) phase comes out more readily. (It would have come out anyway). It will also replace itself more readily and presumably with a hair shaft of greater thickness.
The proprietary preparation is commonly known as Retin-A, manufactured by Ortho Pharmaceutical. Pure retinoic acid is intensely yellow, so that unadulterated compounds of retinoic acid will have a bright yellowish cast. Retinoic acid has been used for more than 25 years in the treatment of acne, and tests using retinoic acid alone to stimulate hair growth have been conducted since as early as January, 1977 when a British patent application was filed and December 1977 when a German patent was filed.
More recently, retinoic acid has been highly touted to reverse the aging of the skin, primarily due to solar exposure. In fact, U-V light is considered to be the chief contributing factor to aging skin. Therefore, unnecessary exposure to the sun is discouraged while using retinoic acid. Basically, the retinoic acid acts like a chemical peel. Erythema (redness), flaking, peeling and mild irritation frequently occurs with the use of retinoic acid, but is usually mild and limited to 7-10 days. As with minoxidil, the effects of retinoic acid on the skin are dose related. The .025% concentration of retinoic acid has become the standardized concentration among dermatologists. True contact allergy to topical retinoic acid is rarely encountered (1). The reaction in the skin is to induce protein synthesis as well as to increase cell turnover. Since retinoic acid is decomposed by strong light, it should only be applied at night.
(1)Nordquist BC, Mehn K: Allergic contact dermatitis to retinoic acid. Contact Dermatitis 3:55-56, 1977
(2)Zbinden G: Pharmacology if vitamin A acid (13-cis, all-trans-retinoic acid). Acta Derm Venereol (Stockh) 55:21-24, 1975
(3)Ferry JJ, Forbes KK, LanderLugt JT and Szpunar GJ: Influence of tretinoin on the percutaneous absorption of minoxidil from an aqueous topical solution. Clin Pharmacol Ther 47:439-46, 1990
INSTRUCTIONS ON HOW AND WHEN TO USE
If you are just starting to use minoxidil containing Retinoic Acid, apply solution only once during first week, twice only during second week, etc., until you have acclimated to it. Apply regular minoxidil solution on all other nights.
Do not use for morning application
Use only for nighttime application
After spironolactone solution has become dry, apply 1 mL to thinning areas of scalp
If flaking, redness, and soreness persists for longer than two weeks, stop using and consult with Dr. Lee at
DrLee@xandrox.com,
