Q: I am 39 years old and just about to start using Minoxidil 5% lotion to manage the hair thinning and falling problem. Please clarify the following: (1) How does Minoxidil 5% work? (2) Does it make the existing hair thick and healthy or does it help to grow new hair? (3) What is the minimum duration to notice the benefits? (4) Can I apply oil to the scalp and wash with shampoos once a week while I am applying Minoxidil 5% lotion?

A:It would be unrealistic to expect major cosmetic benefit from the use of Minoxidil either 2% or 5%, even though the higher strength gives slightly better results. If the baseline hair count is 103-106 per square centimetre, then after 32 months use one can expect 39 new hair per square centimetre. However, if the baseline is 144 to 152 hair, then additional hair are unlikely to exceed 15 per square centimetre. It works by increase in the number of hair, but does not make existing hair thick. The lotion needs to be applied twice a day and nothing else should be applied for at least four hours, so that medicine can have effect. Beyond this four hours, one can wash the hair and apply non-medicated shampoo. It takes a minimum of four months for the effect to take place. If there is no benefit after 12 months, the therapy should be stopped. Cosmetically, the effect is not very encouraging though in terms of hair count there may be some improvement. Minoxidil is to be used only on otherwise healthy, normal scalp.