Application of topical minoxidil in acne vulgaris treatment

• Published in: Dermatologica Sinica Vol. 42; no. 3; pp. 225 - 235
• Main Authors: Chen, Chun-Bing, Kuo, Yung-Chia, Chang, Sun-Min, Lin, An-Chi, Fan, Hsien-Chi, Lin, Tung-Liang, Chung, Wen-Hung, Hsu, Cheng-Lung
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer - Medknow 01.07.2024; Medknow Publications and Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Edition: 2
• Subjects: acne; androgen; androgen receptor; Androgens; Antiacne agents; c. acnes; Drug therapy; Fatty acids; Hamsters; Inflammation; Minoxidil; Original Article; Prostate cancer; Synthesis; Tetracycline; Tetracyclines; Taiwan; androgen; androgen receptor; minoxidil; Acne
• ISSN: 1027-8117; 2223-330X
• DOI: 10.4103/ds.DS-D-24-00105

Abstract Background: Acne vulgaris (AV) results from increased sebum production and Cutibacterium acnes (C. acnes) overgrowth, leading to pilosebaceous unit inflammation. The androgen-androgen receptor (AR) pathway significantly contributes to acne development, with minoxidil showing promise in suppressing AR-related activities. Objectives: This study aims to examine the mechanism and effectiveness of minoxidil in treating AV. Methods: The effects of minoxidil on lipid metabolism and bacterial infection/inflammation were tested. A clinical trial was performed to evaluate the effect of topical minoxidil on AV. Results: Minoxidil suppressed fatty acid synthase activity and lipid formation in an androgen-sensitive prostate cancer cell line in vitro and sebum formation in hamster flank organs in vivo. For C. acnes, minoxidil had a half-maximum inhibitory concentration of 5 mM. Both 2% and 5% minoxidil suppressed C. acnes-induced infection/inflammation in an animal model. A phase I/II clinical trial of topical minoxidil in treating AV using a split-face model demonstrated a good response and well-tolerated side effects. Compared to the untreated side, the numbers of all types of lesions decreased significantly on the treated side on day 3 (mean: −2.238, 95% confidence interval [CI]: −3.821 to −0.655, P = 0.008), day 8, and reached the maximum effect on day 15 (mean: −1.286, 95% CI: −2.151 to −0.420, P = 0.006). Responders to topical minoxidil may experience rapid regression of acne as early as 3 days of treatment. Conclusion: Our collective data indicate that minoxidil could inhibit AR-related functions and C. acnes growth in treating AV.