South Africa: A recent case report published in JAAD Case Reports, reports the case of an African woman with frontal fibrosing alopecia (FFA) in whom pleural, pericardial effusion and anasarca developed three weeks following low-dose oral minoxidil (LDOM) therapy.

For many years, topical minoxidil has been used for treating androgenic alopecia and other hair disorders. The mechanism of action of minoxidil is not clearly understood. Still, animal studies have shown that it affects the hair growth cycle by reducing the telogen phase and prolonging the anagen phase. Lately, there has been increasing evidence to support the successful use of LDOM for treating various types of alopecia. The dosing regimens vary from 0.25 to 5 mg daily to twice daily; side effects are reportedly dose-dependent.

The case in question is of a 40-year-old, healthy, Black South African woman with no comorbidities. She presented with a 2-year history of hairline loss involving the frontal and temporal hairlines. A dermatoscopic examination and histologic findings confirmed the clinical diagnosis of frontal fibrosing alopecia. The patient was given the following treatment:- 5% topical minoxidil, clobetasol propionate ointment, tacrolimus ointment 0.1%, twice daily 100 mg of doxycycline, and 0.25 mg of oral minoxidil (OM) daily. She was informed about the adverse effects of all the medications.
Following three weeks of the treatment, there was swelling in both lower extremities of the patient, which progressively spread to the upper extremities and face; she was advised to discontinue oral minoxidil and present for follow-up; she was admitted to the hospital for additional workup and further management by a cardiologist.
Following various assessments, the authors excluded other causes of anasarca and pericardial effusion in the previously healthy young woman, concluding that low-dose oral minoxidil was responsible for clinical presentation.
Ncoza C. Dlova, University of Kwazulu Natal, KwaZulu-Natal, South Africa, and colleagues stated in their study, "to the best of our knowledge, the occurrence of pleural, pericardial effusion and anasarca with the LDOM use for alopecia has not been reported in the literature."
"Our extensive workup of the patient did not indicate any obvious underlying cause; thus, we conclude that the woman's presentation was a rare side effect and should be documented to alert other clinicians to be careful about this uncommon adverse effect of LDOM."
They added, "we have since advised patients to initiate alternate days of LDOM for one month and, after that, increase it to daily dosages. This case report alerts clinicians to be mindful of this potential side effect."
Reference:
Dlova NC, Jacobs T, Singh S. Pericardial, pleural effusion and anasarca: A rare complication of low-dose oral minoxidil for hair loss. JAAD Case Rep. 2022 Aug 11;28:94-96. doi: 10.1016/j.jdcr.2022.07.044. PMID: 36117778; PMCID: PMC9478873.