Expert Consensus Addresses Oral Minoxidil Use for Pediatric Hair Disorders

A JAMA Dermatology consensus statement addresses the lack of standardized guidance for off-label low-dose oral minoxidil in children younger than 12 years with hair disorders. Informed by a literature review, the modified Delphi process ran from June 2025 to March 2026. Fifty experts from nine countries completed the first two rounds, and 49 completed the third. Consensus required at least 70% agreement.

Of 127 initial items, 84 achieved consensus. Experts supported use in children aged 4 to younger than 12 years for follicle miniaturization and hair cycle abnormalities (both 100% agreement), hair shaft disorders (84%), and adjunctive treatment of selected scarring alopecias (98%). Reasons to prefer oral over topical minoxidil included application difficulties, tolerability, inadequate efficacy, and caregiver preference.

Both fixed weight-based dosing and a starting dosage of 0.01–0.02 mg/kg/day reached consensus. Listed fixed doses were 0.250–0.625 mg for children weighing less than 20 kg, 1.250 mg at 20–40 kg, and 1.875 mg above 40 kg. Experts also agreed on dose escalation of 50%–100% and reassessment every three to six months. Contraindications included pericardial effusion or tamponade and pheochromocytoma.

The panel considered routine baseline testing and blood pressure monitoring not universally necessary for low-risk patients. These recommendations offer a pediatric prescribing framework, but do not establish efficacy or safety through comparative clinical outcomes. Only the abstract was available for this update, limiting assessment of the supporting evidence and detailed monitoring guidance.