Rogaine+retin and periorbital edema

[Hair2012]

I have been using Rogaine 5% for over 25 years without any side effects. I recently switched to a minoxidil-azelaic acid-retin-A combo. After 2 weeks I started to get periorbital edema,headache and shortness of breath. these side effects are possibly due to too much minoxidil absorption because of the retin-a which enhances absorption of minoxidil. so I stopped it and side effects went away except the periorbital edema.Its been 5 days since I stopped it.

 

Does anyone have experience this type of side effect (periorbital edema) and how long does it take to go away ?

 

Thanks

Edited October 14, 2012 by Hair2012

[Dr Tom Walker]

I have had a few patients with this side effect and I know that it can be quite upsetting.

 

Increase your fluid intake and massage the area to enhance lymphatic drainage.

 

The few clients I have had with this swelling found that it went within 2 or 3 days, but I told them to do this immediately.

 

Is there any redness? Do you feel that your eyelids are swollen?

 

Dr Tom Walker

[Hair2012]

Dear Dr.Walker, first of all thank you for your response. There is no redness but my lower eyelids are swollen like racoon eyes. The symptoms that I had periorbital edema,headache and shortness of breath led me to believe that overabsorption of minoxidil due to retin-A was the culprit.The headache and shortness of breath went away in about 24-48 hours after stopping this combo. I am at day 6 in my periorbial edema is starting to decrease.I would say the decrease is about 50% from baseline.

 

I will continue to monitor the situation and only restart Rogaine foam 5% when all is resolved.

 

Do you find that retin-A increases minoxidil side effects in your practice ?

 

Aside from massaging the area and increasing fluid intake would a diuretic or oral corticosteroid help reduce the edema ?

 

After trying Propecia (6 months) I stopped because of gyno. I tried both Azelaic acid and 5% topical spironolactone and despite that they say that very little little is absorbed I got Gyno after less than a week on both regimen. So beware they do block DHT or the androgen receptor ?

 

Any other regimen that you would recommend along with rogaine to block DHT (aside from ketoconazole) ?

 

Thanks

[Dr Tom Walker]

It is hard to determine whether any side effects are due to retin-A alone or when in combination.

 

I have some patients using retin-A alone for facial fine lines and this can cause inflammation. It also lowers the threshold in which your skin burns when exposed to the sun.

 

I would try reintroducing the minoxidl sooner rather than later. Try a small area you can monitor and if there is no significant reaction then continue as normal.

 

Try an antihistamine to reduce the swelling. I could not recommend corticosteroids without medical supervision (but I would not use them myself). Diuretics would just give a small initial improvement but could cause rebound bloating, making it look worse, as well as many other side effects.

 

Six months of propecia could have easily caused some gynecomastia. Some people use tamoxifen or anastrozole to combat this but it is a massively understudied area.

 

I have never heard of azelaic acid causing gynecomastia. It would be very unlikely to develop any gynecomastia after less than a week of anti androgenic treatments as glandular tissue takes longer to significantly develop. It was most likely vascular engorgement of an area of existing tissue.

 

The primary treatment plan that I recommend is minoxidil, propecia and bimatoprost.

[Hair2012]

Since Azelaic acid blocks type 1 and type 2 5-Alpha reductase like Propecia (blocks type 2 only) I believe it can cause Gynecomastia like Propecia if absorbed systemically even know I have applied it only topically.I know that sound hard to believe but I have witnessed it within 5 days with both Azelaic Acid and topical spiro (this is a known side effect of spiro)

 

About Bimatoprost, do you recommended in combination with Rogaine ? Is it used once a day ? Is it better than Rogaine ? Have you seen good results in growing hair or stopping hair loss ? Any side effects ? I guess it does not solve the DHT problem if you can't use a DHT blocker orally or topically ?

 

Thanks

[Dr Tom Walker]

I understand the inhibition of 5 a-reductase by azelaic acid but i do not think that it could block enough to make a large systematic change that would result in gynecomastia.

 

I know that spironolactone can cause gynocomastia orally fairly quickly but again, I find it hard to believe that enough could be absorbed via the skin to have an effect so quickly.

 

I truly believe that there is a small amount of glandular tissue present already and it is vascular engorgement due to the addition of the treatments.

 

Bimatoprost should be used once a day. Use any morning treatment as normal then in the evening use bimatoprost mixed with minoxidil.

 

Split the head into 5 areas (frontal, vertex/crown, both sides/occipital, back/nuchal/occipial)

 

Apply enough minoxidil to cover the area to your palm. Add one droplet of bimatoprost and mix.

 

Apply this to one area, then repeat til all 5 have been treated.

 

There is no evidence to say it is better or worse than minoxidil, but it is a prostaglandin analogue so works in a fundamentally different way.

 

Does not effect DHT levels but is an excellent additional treatment, especially for female hair loss/thinning.

 

Primary side effect is inflammation.

 

I have been involved with the treatment for 5 years. Initially it was only for eyelashes but the feedback from using it on eyebrows and scalp has been fantastic. The makers of Latisse are also doing trials and hope to get FDA approval for scalp hair loss.

[Hair2012]

Thats what I thought also that Azelaic Acid 5% or Spiro 5% would not be absorbed systemically enough to cause side effects but they are (in my case) as soon as I stop application my chest returns to its normal state within 24-48 hours. I asked my local pharmacist to do a mixture of 2% Azelaic acid with minoxidil 5% and see if my chest inflates again with a lower concentration of Azelaic acid.

 

It is now 8 days since I stopped taking the Minox 5%-RetinA-Azelaic Acid combo and my lower eyelid is still swollen but a little less than 2 days ago (I hope this is not permanent). This has been going on since Sept 4th (A month and a half) . I would stop everything and restart it after 4-5 days after swelling had gone down a bit. That why I am reluctant to restart until the lower eyelid swelling is gone.

 

I don't believe that I have any congestive heart failure, kidney or liver problems that could be related to eyelid swelling. I am 48 healthy bodyweight, exercise 4 times a week no alcohol or substance abuse.

 

Should I give it another week before seeing my family physician as the condition has improved but its very slow. Is is normal ?

[Dr Tom Walker]

Normal is not clear in this arena as it is a poorly researched treatment regime!

 

It does sound rather odd and I think getting checked out if there is no improvement is a good idea. Keep in mind that you might not receive an explanation or effective treatment as it is an odd and niche situation. At least they should rule out that it is not anything to worry about.

[Hair2012]

Your absolutely right, when I showed my swollen eyelids to my dermatologists he said that it could not be because of minoxidil or the ketoconazole shampoo. He said that skin looses elasticity as you age in that may explain the puffy eyes without further investigation.While this could be true to a certain point it does not happen overnight. You don't go to bed looking fine and waking up the next morning with heavy bags under you eyes,headache and shortness of breath, all minoxidil overabsorption symptoms ( I read that retina-a triples the minoxidil absorption which is probably the culprit).

[Dr Tom Walker]

It is good that you are doing so much research yourself - I encourage as many people to read up on their treatments. I launching a website in the near future that lists all of the research I have found, good or bad, on all the various treatments available.

 

Remember that when it comes to inflammation, the mechanism is designed to come on quick but wear off slow. This makes sense for healing tissue. Continue with a good fluid intake, massaging the area and it will clear up with time. That might not be the answer your wanted to hear initially but I only give my honest opinion.

[Hair2012]

Hi, here is my update at day 14 of stopping minoxidil-retinA-Azelaic acid combo. Things are improving but very slowly. As you said tissue inflammation comes quickly but goes away slowly. I would say that swelling is down about 60-65% from baseline. I looked at the Loniten product monograph and this drug when given orally must be given in combo with a diuretic because it can cause severe edema/fluid retention. Since I got shortness of breath as a symptom I must have absorbed quite a bit of minoxidil. Will continue to monitor the situation until I get back to normal before restarting Rogaine 5% (without retina-a).

 

On the good side I have started using N2 shampoo (caffeine based shampoo) and it really thickens my hair and seems to slow down/stop hair shedding. This is one of the best shampoo for hair loss that I have used along with Regenepure shampoo (1% ketoconazole).I know that in England there is a similar shampoo called Alpecin C1 that is very popular for hair loss. they claim that caffeine blocks DHT in the scalp for 24 hours, so it must be used daily.What are you thoughts on caffeine based shampoo for hair loss ?

[Dr Tom Walker]

I am not 100% convinced that it makes a big difference.

 

Here is a recent paper that, in my opinion, sits on the fence as well:

Role of caffeine in the management of androgenetic alopecia Bansal M, Manchanda K, Pandey SS - Int J Trichol

 

One thing that may be a negative is that it could increase the barrier effect of the skin, thus lowering absorption of other chemicals (minoxidil etc)

Caffeine improves barrier function in male skin - Brandner - 2006 - International Journal of Cosmetic Science - Wiley Online Library

[Hair2012]

Day 21 update: Swelling is going down slowly (about 75% from baseline). swelling is going down faster on the right side than on the left side (possibly due to my sleeping position).

 

Quick update on Caffeine shampoo. So far so good. It seems to have stopped my hairloss or at less minimize it (with daily use). Hair has more fullness and bounce to it. I have also noticed some fine vellus hair starting to sprout around the temple area. This shampoo seems too effectively block DHT and help miniaturized hair to start regrowing. I have read a lot of positive reviews on the internet even know there are no large phase 3 clinical trials and I doubt anyone would invest millions of dollars to do one because there is not patent protection.In my case it seems to work even better than ketoconazole (1%) shampoo.

 

Did any of your patients report success using it or Ketoconazole based shampoo ?