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Alopecia and ocular alterations: a role for Minoxidil?

Research into ocular alterations in alopecia patients is limited and tends to overlook hypertrichotic agents medication. It was very recently reported that retinal changes in the form of degenerative changes, pigmentary clumping, and abnormal vascular changes are significantly more prevalent in alopecia areata (AA) patients than in the sex- and age-matched controls (1). Symptomless punctate lens opacities were significantly higher in patients than in control patients. Also, fundus alterations were significantly higher in AA patients than in the controls (2). Ophthalmological examinations showed significantly higher percentages of lens changes and alterations in the retinal epithelium in AA patients than in the controls (3). However, there is currently no proposed mechanism to explain this observation. Ocular findings are not rare conditions in other types of alopecia. In fact, a review of the literature will reveal a considerable number of similar reports. It would be difficult to establish a precise figure on what percent of AA patients or other types of alopecia patients apply topical Minoxidil. However, if it proved to be a significant figure, it would logically account for at least part of the high number of cases with retinal changes in patients using this agent. As there is scant data in the literature regarding possible angiogenic properties of Minoxidil—a potent hypertrichotic agent and one of the most commonly used medications in alopecia—the relation of an anti-hair loss product to retinal changes is less well-documented and has received little attention. The problem with Minoxidil is that it lacks tissue selectivity (4).