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Swelling Around the Eyes (Periorbital Edema) in Oral Minoxidil Users: A Closer Look at Two Cases.


Periorbital Edema Occurs in A Small Proportion of LDOM Users – But is Probably Underestimated.

Periorbital edema refers to swelling around the eyes. It can occur with use of low dose oral minoxidil for hair loss. The puffiness can be severe in some cases – mimicking an allergic reaction. Estimates suggest that 0.3 to 1 % of users of low dose oral minoxidil have this side effects. In the 2021 study for Vano-Galvan et al, periorbital edema was estimated at 0.3 % following review of 1404 patients. In Sanabria’s 2021 study, the estimate was put at 1 % following very careful review of 435 users.

Mir-Bonafé et al. 2023

In a new report, authors describe 2 patients who developed periorbital edema associated with the use of low dose oral minoxidil.

Figure 1 from the 2023 paper by Mir-Bonafé  et al. Part A (left) shows periorbital edema in the 40 year old male patient using 5 mg nightly. Figure B (right) shows the periorbital edema in the 37 year old female patient using 1 mg nightly. SORUCE: Mir-BJ F Mir-Bonafé  et al. Morning Periorbital Edema Related to Low-Dose Oral Minoxidil. Actas Dermosifiliogr. 2023 May;114(5):460-46. used with CC license.

 

Patient 1 was a 40 year old male with AGA who started taking 5 mg nightly. After 4 weeks, he noticed that he was getting swelling under his eyelids in the morning.  Interestingly, the swelling resolved during the day. There were no other signs of edema – such as pedal edema or respiratory or cardiac issues. He reduced from 5 mg to 3 mg and had complete resolution

Patient 2 was a 37 year old female who started oral minoxidil 1 mg oral minoxidil nightly. After 2 weeks, she noticed periorbital edema. Similar to patient 1, the swelling resolved but here is resolved even quicker – with resolution in 60 minutes of awakening.  There were no other signs of edema – such as pedal edema or respiratory or cardiac issues. The patient ultimately decided to stop treatment for a short time – and everything resolved in 7 days. She then reintroduced oral minoxidil at 0.5 mg nightly and did not have any periorbital edema.

 

 

Comment

This is a nice case series of 2 patients reminding us of the fluid retention that can occur with oral minoxidil. some patients do develop periorbital edema without swelling in the feet. In fact, it’s probably much more common than we realize as many patients attribute the swelling under the eyes to their morning appearance or poor sleep or some other factor.

Vano-Galvan put the risk of periorbital edema at 0.3 % in their study of 1404 patients and Sanabria put the statistic at 1 % based on 435 patients.  The risk seems to be dose dependent – with higher risk in those using higher doses. All in all, this statistic is probably underestimated given how quickly it can appear in some patients.

One must never be so confident as to claim that really low doses – like 0,25 mg are risk free. Dlova’s report reminds us that even 0.25 mg can have serious consequences – albiet extremely rarely.

REFERENCE

J F Mir-Bonafé  et al. Morning Periorbital Edema Related to Low-Dose Oral Minoxidil. Actas Dermosifiliogr. 2023 May;114(5):460-46

Sanabria B et al. Adverse effects of low dose oral minoxidil for androgenetic alopecia in 435 patients. JAAD 2021; 84: 1175-78

Vano-Galvan S et al. Safety of  low dose oral  minoxidil for hair loss:  A multicenter study of 1404 patients. JAAD 2021; 84: 1644-51.



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