NOTE: The first version of this article is written for laymen. For those who want a more scholastic understanding of these various topics, please read the second section.
What are the Medications That Work for Treating MPB?
What Can Be Expected From Treatment?
WHICH MEDICATIONS ARE MOST EFFECTIVE FOR TREATING MPB AND HOW SHOULD I USE THEM?
(Layman's version)
All medications being offered in this web site are briefly discussed in this article. For more thorough explanations of each medication, please access the information in the FAQ’s.
FDA approved hair regrowth drugs are generally classified into two separate categories: hair regrowth stimulants and anti-androgens or DHT inhibitors. Our most potent products are Xandrox™ , which are a combination of both a regrowth stimulant (minoxidil) and a DHT inhibitor (azelaic acid), and Xandrox15-PLUS, which is a combination of a regrowth stimulant (minoxidil), and two DHT inhibitors (azelaic acid and finasteride).
APPLICATION OF 5% XANDROX DAY SOLUTION AND 5% MINOXIDIL DAY SOLUTION;
The most effective and most important approach to the use of topical 5% Xandrox or plain 5% minoxidil solution is compliance. Apply the solution of choice twice a day, every day. Each such application should be applied a minimum of 8 hours apart. It is
important to apply the medications directly onto one's scalp, where they will do the most good.
Step one: Draw up 1 mL of 5% Xandrox or plain 5% minoxidil solution into the provided medicine dropper.
Step two: Part hair in several places and apply a portion of the medicine to each parted area.
Step three: Use fingertips to distribute the solution to cover the thinning areas of the scalp. If the hair is parted in six places, use the medicine dropper to deposit a total of about 1/6th mL of solution per each parted area of the scalp. Exact precision isn't necessary, as it's the alcohol in the 5% solutions that allows for penetration into the scalp. Even if the 5% solution is not evenly distributed on the scalp, diffusion takes place in the skin layers directly under the stratum corneum. The stratum corneum is the protective, uppermost layer of dead skin cells generally known as the horny layer.
Step four: Most patients will experience satisfactory regrowth with 5% Xandrox or even the less potent 5% minoxidil within 4 to 6 months. If, after 6 months of treatment with 5% Xandrox daytime or 5% minoxidil daytime solution one finds there are still areas
that are not responding adequately to treatment, one may add the 5% Xandrox or 5% minoxidil Nighttime solutions to the therapy regimen. DO NOT STORE MINOXIDIL OR XANDROX SOLUTIONS IN YOUR REFRIGERATOR. STORE THEM AT ROOM TEMPERATURE.
5% XANDROX AND 5% MINOXIDIL NIGHTTIME SOLUTIONS CONTAINING RETINOIC ACID (RETIN-A™)
If one wishes to use 5% Xandrox or minoxidil solutions which contain retinoic acid (Retin-A™), please be aware that the solutions may cause temporary irritation, and/or flaking and drying of the scalp where applied. This may occur because of retinoic acids'
direct effect as a chemical peel. Retinoic acid solutions may also cause the skin to be more sensitive to sunburn. As such, it may be wise to undertake protective measures. These measures include, but are not limited to using sunscreen with a SPF (sun
protection factor) of at least 15. One may wish to wear a hat if full exposure to direct sun is anticipated. Under all circumstances, one should acclimate one's self to retinoic acid by applying it once-only (at night) during the first week of therapy, twice-only during the
second week, etc., until one is able to use it every night. During this acclimation period, be sure to apply 5% Xandrox or plain 5% minoxidil solutions (which do not contain retinoic acid), in the morning.
A patient's sensitivity to retinoic acid varies. As a rule, the more fair one's complexion is, the more severe the initial flaking/scaling might be with retinoic acid's use. Since retinoic acid is used as a chemical peel, almost all patients will have some initial reaction to its’ use.
If one cannot acclimate to the use of retinoic acid and has continuing scalp irritation, its’ use should be discontinued and the patient should switch back to twice daily applications of the formulas that do not contain retinoic acid.
SPECIAL NOTE: The use of retinoic acid is not recommended for patients who are being treated for acne with Accutane.
SOLUTIONS CONTAINING PROPYLENE GLYCOL
Rogaine Extra Strength™ and all generic versions of 5% minoxidil contain a 50% concentration of propylene glycol in their base formula. This high concentration of propylene glycol increases the shelf life of the 5% minoxidil solutions, but it also
makes the solutions feel 'greasy,' and some patients experience skin irritation in reaction to the propylene glycol.
The 5% Xandrox and plain 5% minoxidil solutions formulated by Regrowth contain 30% propylene glycol in their base formulas. This lower amount of propylene glycol minimizes the 'greasy' feeling.
Xandrox and minoxidil solutions that contain no propylene glycol are also available from Rgrowth, LLC. In place of propylene glycol, they contain non-allergenic glycerin. These solutions should only be used by individuals who are allergic to propylene glycol in any concentration, as the glycerin makes the solutions have a 'greasy' feeling akin to Rogaine Extra Strength™ or the 5% generic versions of minoxidil.
APPLICATION OF 12.5% XANDROX LOTION, 12.5% MINOXIDIL SOLUTION, XANDROX15 OR XANDROX15-PLUS IN COMBINATION WITH 5% XANDROX SOLUTION
12.5% XANDROX LOTION: Use 1 mL of 5% Xandrox solution twice daily on all affected areas of the scalp. Several minutes after the nighttime application of 5% Xandrox, apply no more than 1 mL of the Xandrox 12.5% lotion ONLY to those areas, which are not responding satisfactorily to the 5% solutions. The 12.5% Xandrox lotion contains benzyl nicotinamide, which may cause temporary flushing. The possible flushing is one of the reasons the lotion is best applied only at night. Another reason is so that the minoxidil will absorb better.
12.5% MINOXIDIL SOLUTION, XANDROX15 OR XANDROX15-PLUS: Use 1 mL of minoxidil and/or Xandrox solutions twice daily on all affected areas of the scalp. It is recommended that the higher concentration minoxidil formulas, i.e. 12.5% Minoxidil Solution, Xandrox15 and Xandrox15-PLUS, be used at night, when they can remain on the scalp for maximum absorption. The 5% Xandrox can be used as the daytime dosage.
POTENTIAL SIDE EFFECTS ASSOCIATED WITH 12.5% XANDROX LOTION
It is best not to apply more than 1 mL of the higher concentration Minoxidil or Xandrox formulations more than once daily. Even though it is rare, some patients have reported systemic effects from even the 5% Xandrox and minoxidil solutions. These reports have included rapid heart rate, a drop in blood pressure, water retention, swelling in hands and feet, and dizziness. If any of these symptoms occur, stop using any medications containing minoxidil.
TEMPORARY SHEDDING ASSOCIATED WITH MINOXIDIL BASED PRODUCTS
A small percentage of patients, male and female, experience slightly increased shedding of hair when they start using any topical minoxidil products. This shedding is normally a one-time occurrence and affects only the hair shafts which are in the telogen phase. Telogen phase hair shafts are those that have finished the growth cycle, are ready to fall out, and usually represent about 10% of the total hair shafts on the scalp at any given period of time. Although shedding associated with hair regrowth drugs is understandably frustrating, the shedding is actually a good indication that the patient's therapy is working like it is supposed to work. Ultimately, all telogen hair shafts which have been shed, will be replaced with new hair shafts, which are thicker, remain on the scalp longer, and are more heavily textured. One is reminded of the slogan used when muscle tissue is increased through strenuous exercise: 'No pain. No gain.' Few therapies associated with body enhancement are instant, and it takes almost as long to regrow hair as it did to lose it.
The hair replacement period requires that the telogen (resting) phase be completed, which normally takes approximately 100 days.
A TREATMENT…..NOT A CURE
Hopefully genetic engineering or stem cell research will develop a cure to MPB. Until that time comes, there are only regrowth treatments available. There are misconceptions about developing a 'tolerance' to minoxidil. Minoxidil will, indeed, help to recruit atrophic follicles to grow thicker hair for about two to three years. Minoxidil then helps to keep the hair in the anagen phase, so the newly regrown hair will not atrophy and shed prematurely.
Because some patients do not continue to see significant improvement after a few years of therapy, they assume the body has developed a tolerance to minoxidil, and that it is no longer 'working'. If they stop minoxidil therapy, the hair they have regrown because of the minoxidil treatment will shed within 3-4 months. In essence, minoxidil has fooled the body into regrowing and keeping hair, which was preprogrammed to be lost. Until a cure is available, don't deprogram the success you have earned.
After two to three years of treatment, many patients are able to maintain their regrowth with a once daily application of 5% Xandrox or 5% minoxidil.
FINASTERIDE (PROPECIA™) AS A TREATMENT FOR MALE PATTERN BALDNESS
Finasteride is a DHT inhibitor. One mg of finasteride should be taken once daily. It can be taken with or without food.
In summary, there are two known pathophysiologic pathways that cause Male Pattern Baldness (MPB).
1) The shortening of the anagen phase of the hair growth cycle, which can be treated with high concentration minoxidil.
2) The immune inflammatory response from scalp dihydrotestosterone (DHT), which causes the miniaturization of the hair follicle, and is treated with inhibitors such as topical azelaic acid, topical spironolactone and oral finasteride.
Like azelaic acid and spironolactone, finasteride helps to protect the follicles from DHT.
Drugs such as finasteride (Propecia™), the azelaic acid in Xandrox and spironolactone reduce DHT in the scalp. However, simply reducing the DHT level in the scalp isn't the entire remedy for MPB. Men who have been castrated for treatment of prostate cancer and have no available source of DHT will stop balding, but they will not grow back significant amounts of hair unless they also use minoxidil as a hair growth stimulant. It's the combination of minoxidil and a DHT inhibitor, which leads to regrowth.
As a rule, one would not need to use finasteride, if using Xandrox. But as in all biological systems, there will be variations in response. That is, it is not unusual that a patient responds to one proven medication and not another, even though, in most cases, the medications have demonstrated the same end result. Finasteride works for many patients, but it does not work for all patients. The same can be said for azelaic acid in inhibiting DHT.
Although it is safe to use Xandrox and to take finasteride at the same time, in most cases it is unnecessary to use them concomitantly.
Oral finasteride may lower the serum level of DHT by 60-80%. But the DHT reduction at the actual follicle is far less than 60%-80% because the predominant enzyme that converts testosterone to DHT in the scalp is type 1, 5-alpha reductase, which is not inhibited by finasteride.
On the other hand, the 5% concentration of azelaic acid in Xandrox will inhibit virtually all synthesis of DHT in the scalp where it is applied. It does this by inhibiting the synthesis of testosterone into DHT of both type 1 and type 2, 5-alpha reductase enzymes.
The extra reduction of DHT via azelaic acid helps many patients grow hair who would not otherwise be able to do so.
POSSIBLE SIDE EFFECTS ASSOCIATED WITH FINASTERIDE
When male patients take oral finasteride, a significant number report a decrease in libido, and a smaller number report "ache in the groin area." Also, a small number of men experience erectile dysfunction. These negative side effects are usually reversible within several days of discontinuance of taking finasteride. Even if one continues to take finasteride, the majority of men will gradually regain their former libido.
Tell your doctor you are taking finasteride, if you are going to have a blood test for PSA (Prostate Specific Antigen), which can be an indicator of prostate cancer. Taking finasteride will decrease the PSA value by ~50%.
WHAT CAN BE EXPECTED FROM XANDROX, MINOXIDIL AND SPIRONOLACTONE THERAPY?
Using a combination of 5% minoxidil in combination with a drug to effectively reduce scalp DHT (e.g. 5% Minoxidil and 5% spironolactone, finasteride or Xandrox) stops any further progression of MPB and regrows hair in 83% of patients. Up to 70% of patients restore atrophying follicles back to cosmetically acceptable hair. Approximately 50% restore frontal hair. The remaining 17% will have their rate of loss slowed down, but will continue to lose hair.
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WHAT ARE THE MEDICATIONS THAT WORK FOR TREATING MPB?
(More scholastic version)
Knowledge of the normal hair physiology and the understanding of the pathophysiology of alopecia androgenetica, more commonly known as male pattern baldness or MPB, has dramatically expanded in the past two decades. Currently, there are two effective approaches to treating MPB: (1.) Stimulate the hair follicle to produce a thicker hair shaft and to remain in the anagen (growth) phase and (2.) Decrease the dihydrotestosterone [DHT] in the scalp to prevent the immune inflammatory reaction that harms and miniaturizes the follicles.
There is only one FDA-approved, safe, and effective way to stimulate growth in the hair follicles: topical minoxidil. Topical minoxidil is dose related, so the more minoxidil that can be delivered to the hair follicles, the better its’ ability to stimulate hair growth.
On the other hand, there are several ways to decrease the amount of DHT in the scalp. Oral finasteride has been in use for many years to decrease the amount of DHT in the prostate. In 1997, the FDA approved this same medication in a decreased dosage to treat MPB.
DHT in the scalp can also be reduced by topical medications. One of the most effective topical medication for this purpose is azelaic acid. Azelaic acid is also an FDA approved medication and has been used for the treatment of acne. Many well-designed studies have proven that azelaic acid very effectively inhibits the synthesis of DHT in the skin.
An alternative topical medication for decreasing DHT in the scalp is spironolactone. Spironolactone is an anti-androgen. It prevents the formation of DHT in the scalp and locally increases the amount of the female hormone, estrogen. Spironolactone also is a competitive inhibitor of DHT at the androgen receptor sites, helping to prevent DHT from attaching to the receptor sites on the hair follicles.
Finasteride can also be used topically to reduce the amounts of DHT in the scalp.
In summary, the best approach to treating MPB is to simultaneously stimulate hair growth and to decrease or eliminate the DHT in the scalp. The available effective medications are 5% Minoxidil Daytime and Nighttime Solutions, Xandrox 5% Daytime and Nighttime Solutions, Xandrox 12.5% Lotion, 12.5% Minoxidil Solution, Xandrox15, Xandrox15-PLUS, finasteride and topical spironolactone.
How to Apply 5% Xandrox and/or 5% Minoxidil Solutions
Start your treatment by using 5% minoxidil or 5% Xandrox liquid twice daily. It is important to apply the topical minoxidil or Xandrox directly onto your scalp, where the medicine will absorb most effectively. Fill the medicine dropper with 1 mL of liquid. If you have pattern baldness, apply the 5% minoxidil or Xandrox liquid to the areas of hair recession or balding areas. If your hair loss is generalized, part your hair in as many as six places and apply a portion of the 5% minoxidil or Xandrox liquid in the medicine dropper to each of these areas. You can use your fingertips to distribute the fluid more evenly. In solution form, it is the alcohol that allows for penetration of minoxidil and azelaic acid into the scalp, so massaging the scalp has no appreciable benefit. Even though the minoxidil or Xandrox is not evenly distributed on the scalp, there is sufficient diffusion in the layers under the surface of the skin to allow for effective total coverage.
A consistent, twice/day application is the most efficient manner to use topical 5% minoxidil or Xandrox to treat male pattern baldness. Most patients will have a satisfactory response to 5% minoxidil (at the vertex) or to Xandrox 5% solution (at the vertex, crown and frontal areas) in 4 to 6 months. However, if after 6 months of treatment with the liquid, you find that there are remaining areas that are poorly responsive, you may want to consider using a higher concentration minoxidil formulation such as 12.5% Xandrox lotion, 12.5% Minoxidil Solution, Xandrox15 or Xandrox15-PLUS, in addition to the 5% solutions.
After two to three years of treatment, you may maintain your hair growth with a single daily application of 5% Xandrox or 5% minoxidil, but it is unlikely that you will recruit any more hair follicles to regrow thicker hair shafts.
How to Combine the Use of 5% Xandrox Solution with 12.5% Xandrox Lotion, 12.5% Minoxidil Solution, Xandrox15 or Xandrox15-PLUS
12.5% XANDROX LOTION: Use 1 mL of 5% Xandrox solution twice daily on all affected areas of the scalp. Several minutes after the nighttime application of 5% Xandrox, apply no more than 1 mL of the Xandrox 12.5% lotion ONLY to those areas which are not responding satisfactorily to the 5% solutions. The 12.5% Xandrox lotion contains benzyl nicotinamide, which may cause temporary flushing. The possible flushing is one of the reasons the lotion is best applied only at night. Another reason is so that the minoxidil will absorb better.
12.5% MINOXIDIL SOLUTION, XANDROX15 OR XANDROX15-PLUS: Use 1 mL of minoxidil and/or Xandrox solution twice daily on all affected areas of the scalp. It is recommended that the higher concentration minoxidil formulas, i.e. 12.5% Minoxidil Solution, Xandrox15 and Xandrox15-PLUS, be used at night, when they can remain on the scalp for maximum absorption. The 5% Xandrox can be used as the daytime dosage.
Potential Side Effects of Topical Minoxidil
It is extremely rare to have systemic side effects from using topical minoxidil because the amount of absorption (approximately 1.7%) is minimal. The systemic effects of minoxidil can include a rapid heart rate, drop in blood pressure, water retention with swelling in hands and feet, and dizziness. If you experience any of these reactions, stop using any medications containing minoxidil.
Temporary Shedding Initiated by the Application of Minoxidil Based Solutions
A small percentage of patients, male and female, may experience slightly increased shedding of hair when they start using any topical minoxidil product. If it occurs, the shedding is a one-time occurrence and is usually so minor that it goes unnoticed. The shedding affects only the telogen hairs, which are those hair shafts that are no longer growing. At any given time, telogen hair shafts normally represent about 10% of all hair on the scalp. Although shedding can be understandably frustrating and exasperating, in actuality, it's a good prognostic indicator that those same patients will ultimately have good results with their regrowth therapy. All such hair that is shed will be replaced with hair shafts that are thicker. This occurs because the atrophic process is being reversed.
However, replacement of the hair that has been shed usually requires that the loss/regrowth cycle complete its telogen (resting) phase. The telogen phase lasts approximately 100 days.
Minoxidil 'Tolerance'
There are numerous misconceptions about minoxidil and the notion of developing a 'tolerance' to it. Minoxidil will help recruit atrophic follicles grow thicker hair again for a minimum of two to three years. Thereafter, topical minoxidil solutions normally keep hair follicles in the anagen phase.
Unfortunately, because many patients do not see significant continuing 'improvement' after a few years, they assume the minoxidil has caused a tolerance and is no longer working for them. If these patients are convinced to stop minoxidil therapy, all the new hair they have regrown will be shed within 3-4 months.
5% Xandrox and 5% Minoxidil with Retinoic Acid
If one wishes to use 5% Xandrox or minoxidil solutions which contain retinoic acid (Retin-A™), please be aware that the solutions may cause temporary irritation, and/or flaking and drying of the scalp where applied. This may occur because of retinoic acids'
direct effect as a chemical peel. Retinoic acid solutions may also cause the skin to be more sensitive to sunburn. As such, it may be wise to undertake protective measures. These measures include, but are not limited to using sunscreen with a SPF (sun
protection factor) of at least 15. One may wish to wear a hat, if full exposure to direct sun is anticipated. Under all circumstances, one should acclimate one's self to retinoic acid by applying it once-only (at night) during the first week of therapy, twice-only during the second week, etc., until one is able to use it every night. During this acclimation period, be sure to apply 5% Xandrox or plain 5% minoxidil solutions, which do not contain retinoic acid, in the morning.
A patient's sensitivity to retinoic acid varies. As a rule, the more fair one's complexion, the more severe the initial flaking/scaling might be with initial retinoic acid use. Since retinoic acid is used as a chemical peel, almost all patients will have some initial reaction to its’ use.
If one cannot acclimate to the use of retinoic acid and has continuing scalp irritation, its’ use should be completely discontinued and the patient should switch back to twice daily applications of the formulas that do not contain retinoic acid.
SPECIAL NOTE: The use of retinoic acid is not recommended for patients who are being treated for acne with Accutane. The cumulative amounts of retinoids may be harmful to hair follicles.
Allergic Reactions to Propylene Glycol
Rogaine XSTM and the 5% minoxidil solution generics use a 50% concentration of propylene glycol to stabilize their alcohol/water base solutions and to prolong the shelf life. Since Regrowth compounds minoxidil solutions upon demand and uses a 30% concentration of propylene glycol, the solutions remain fresh and avoid the greasiness of Rogaine XS and its generic versions.
As many as 10% of patients will have an untoward reaction to propylene glycol. If you experience scalp irritation due to propylene glycol, use Regrowth’s propylene glycol-free minoxidil and Xandrox solutions. Because non-allergenic glycerin is substituted for propylene glycol, these glycerin-based solutions tend to have the 'oily' texture similar to that of Rogaine XSTM and its generic versions.
Finasteride in the Treatment of Male Pattern Baldness
Finasteride helps to protect the follicles from DHT. When DHT attaches to the androgen receptor sites on the hair follicles of the scalp, it initiates an immune inflammatory response, which damages and miniaturizes the hair follicles.
One mg of finasteride daily will lower the serum level of DHT by 60-80%. However, the amount of reduction of DHT around the hair follicles is only ~37%, because the predominant enzyme that converts testosterone to DHT in the scalp is type 1 5-alpha reductase, which is not inhibited finasteride.
The recommended dosage of finasteride is 1 mg/daily, but because the biological action of finasteride is so prolonged, even large variations of the daily dose are equally effective. Finasteride can be taken with or without food.
When male patients take finasteride, less than 10% of them report a decrease in libido, and a smaller number report an "ache in the groin area” or erectile dysfunction. These negative side effects are reversible usually within two weeks of discontinuance of taking the finasteride. Even when patients continue to take the finasteride, the majority of the men will gradually regain their former libido and the side effects will abate.
When you are getting a physical examination or are having laboratory tests on your blood, inform your doctor that you are taking finasteride. Finasteride will decrease the PSA (Prostate Specific Antigen) level by approximately 50%. Assessing the PSA level is a screening test for possible prostate cancer.
Although finasteride can be used alone for the treatment of MPB, it is much more effective in regrowing hair, if it is used together with topical 5% - 12.5% Minoxidil Solution, or 5% - 15% Xandrox compounds.
Azelaic Acid for the Treatment of Male Pattern Baldness
Many medications have been developed which will decrease the amount of DHT in the scalp. Topically applied azelaic acid has been proven to be one of the most effective inhibitors of DHT synthesis in the scalp. A topical 5% azelaic acid solution will reduce the amount of DHT in the scalp by greater than 98% where it is applied. Xandrox formulations incorporate 5% azelaic acid. The combination of minoxidil and azelaic acid promotes hair growth and prevents atrophy of the hair follicles. The 5% azelaic acid in all of the Xandrox formulations is approximately 3 times the concentration necessary to obtain essentially complete inhibition of DHT synthesis.
When azelaic acid is initially used, it may cause a temporary stinging or burning sensation. Azelaic acid is a naturally occurring substance found in whole grains. There are no harmful direct or side effects to the use of azelaic acid.
Topical Spironolactone for the Treatment of Male Pattern Baldness
Spironolactone is a potent anti-androgen, and it is effective applied topically. It successfully competes with dihydrotestosterone (DHT) for the receptor site on the hair follicles. Within the skin on which it is applied, it also inhibits the formation of testosterone and converts the existing testosterone in the skin to an estrogen. However, there are inherent problems with topical spironolactone formulations. They have a disagreeable odor and are not stable in solution form.
Topical spironolactone is metabolized in the skin and does not affect any other organ system. In about 1% of patients, a rash can develop. If this happens, the patient should not use topical spironolactone.
Topical spironolactone can be used by men and women with MPB. Oral spironolactone is occasionally prescribed for women to treat hair loss, but it is contraindicated in pregnant women because it upsets the estrogen/progesterone ratio. If taken orally by men, there can be serious side effects such as an increased potassium level in the blood, feminizing effects (gynecomastia) and loss of libido.
It cannot be overemphasized that in treating patients with MPB, it is important to simultaneously stimulate hair growth and decrease the DHT level in the scalp. Simply decreasing the DHT level may be totally ineffective in regrowing terminal (mature) hair. For instance, men who have been castrated for the treatment of prostate cancer, and therefore have no source of DHT, will stop the balding process, but will not grow back significant amounts of hair. However, if they also use minoxidil as a hair growth stimulant, most of the men will grow back terminal hair. A combination of minoxidil and an anti-androgen or DHT inhibitor is particularly important for growth outside the vertex/crown area of the scalp.
What Can Be Expected from Treatment?
The average patient will see a positive response to treatment within 4 to 6 months. Using a combination of 5% minoxidil and a drug to effectively reduce scalp DHT (e.g. 5% Minoxidil and 5% spironolactone, finasteride or Xandrox alone) stops any further loss and regrows hair in 83% of patients with MPB. Approximately 70% of patients will see the growth of cosmetically acceptable hair. Of these patients, 50% can expect a restoration of frontal hair. An additional 13% of patients report that MPB has been stabilized, although appreciable new hair growth is not seen. The remaining 17% may continue to lose hair, but the rate of progression of MPB is slowed considerably.
Most patients see a positive response within 4 to 6 months. For other patients the response time takes longer. Most dermatologists recommend refraining from judging a treatment for MPB until there has been at least a year of treatment.
Best Regards,
Richard Lee, M.D.
Chief Consulting Physician