Minoxidil is NOT Recommended for Cicatricial (Scarring) Alopecia
Minoxidil should not be used for cicatricial alopecia caused by an infected sebaceous cyst, as it is ineffective in scarring alopecias where hair follicles are permanently damaged. 1, 2, 3
Why Minoxidil Doesn't Work in Cicatricial Alopecia
- Minoxidil requires intact, functioning hair follicles to stimulate hair growth – it works by prolonging the anagen (growth) phase and increasing blood flow to follicles 1
- Cicatricial (scarring) alopecias permanently destroy hair follicles, replacing them with fibrous scar tissue, making regrowth impossible regardless of treatment 4, 5
- The evidence for minoxidil in scarring alopecias is inconclusive at best, with studies showing poor or no response 1, 2, 3
What Minoxidil IS Effective For
Minoxidil works well in non-scarring alopecias where follicles remain intact:
- Androgenetic alopecia (male/female pattern baldness) – FDA-approved indication 1, 5
- Telogen effluvium – temporary hair shedding 2, 3
- Chemotherapy-induced alopecia – can aid regrowth after treatment completion 4, 1
- Alopecia areata – though evidence is mixed 4, 1
- Early traction alopecia – before scarring develops 1
Critical Distinction: Scarring vs. Non-Scarring
- Non-scarring alopecia: Hair follicles are preserved but dysfunctional – minoxidil can help 5
- Scarring alopecia: Hair follicles are permanently destroyed by inflammation, infection, or trauma – no treatment can restore them 4, 1
- An infected sebaceous cyst that causes scarring creates permanent follicular damage – the area will not respond to minoxidil 4
What TO Do for Cicatricial Alopecia
- Treat the underlying cause first – in your case, address the infected sebaceous cyst with appropriate antibiotics or surgical drainage 4
- Prevent further scarring – early intervention with anti-inflammatory treatments (corticosteroids, antimicrobials) may limit damage in active inflammatory scarring alopecias like lichen planopilaris or frontal fibrosing alopecia 2, 3
- Consider camouflage options – wigs, hair systems, or scalp micropigmentation for established scarring alopecia 4
- Surgical options – hair transplantation may be considered in stable, non-inflammatory scarring alopecia, but not in active infection 4
Common Pitfall to Avoid
Do not waste time and money on minoxidil for areas of established scarring – once follicles are destroyed, no topical or oral medication will restore them 1, 2. Focus instead on treating active inflammation to prevent progression and managing cosmetic concerns through appropriate camouflage techniques 4.