Oral minoxidil for children's hair loss gets a consensus framework

The edition in brief

An international modified Delphi panel of 49 clinicians reached consensus that low-dose oral minoxidil can be used in children aged 4 to under 12 with miniaturising, hair-cycle and hair-shaft disorders, and as an adjunct in some scarring alopecias. Fixed weight-band dosing (0.25–0.625 mg under 20 kg, 1.25 mg at 20–40 kg, 1.875 mg over 40 kg) and a 0.01–0.02 mg/kg/day start both met consensus, with review every 3–6 months; pericardial effusion and phaeochromocytoma were contraindications. This is expert opinion, not trial evidence. A linked registry study of 21,503 kidney transplant recipients in Australia and New Zealand found skin cancer mortality 11.1 times the general population, and keratinocyte cancer mortality 34.5 times. An English cohort found generalised pustular psoriasis associated with three times the all-cause mortality and nearly ten times the sepsis mortality, with earlier onset in Asian patients. In the PEDISTAD registry of 500 children with moderate-to-severe atopic dermatitis, dupilumab showed larger observed improvement than methotrexate or ciclosporin in both White and non-White children.