Introduction

Trioxidil is a triple action hair health complex which contains a plethora of active ingredients that work synergistically to promote hair growth and stimulate thick and robust hair. This triple action hair anti-thinning complex was developed by Foligain – a company based in Scottsdale, Arizona. This product was researched and developed by Foligain in order to deliver vital nutrients to deeper tissues of the scalp in order to reach the follicular units, thereby promoting healthier and thicker-looking hair in the long-term. Additionally, the product contains moisture retaining properties which are conferred by specific ingredients in order to mitigate against dryness and irritation – common side-effects of topical hair-growth products in the wider market.

What are the Ingredients in Trioxidil?

Foligain’s exclusive product is a proprietary blend of niacin, Vitamin B6, folate, biotin, zinc and copper. One of the advantages of this product by Foligain is that all the ingredients that comprise it are naturally occurring. For example, Vitamin B6 has been shown to induce improvement in alopecia areata amongst women with hair loss in a 2001 study [1], and is naturally found in fortified breakfast cereals, poultry, bananas, beef and dark chocolate. Folate (also known as folic acid) which is found in leafy green vegetables such as spinach and kale is essential for the production of thick hear – deficiencies in this compound can lead to hair loss[2]. The B vitamins such as Vitamin B2 (riboflavin) and Vitamin B7 (biotin) are significantly vital in the cellular development and function of the hair follicles – severe deficiencies in these vitamins have been reported in people who are either malnourished or who undertake strict diets (e.g. veganism) and are characterized by severe, widespread hair loss [3]. Vitamin B7 (biotin), a core ingredient of this product, can be found in natural sources such as chicken liver, eggs, avocados, salmon and sunflower seeds.

Niacin (nicotinic acid) is a form of Vitamin B3 and is an essential human nutrient that can be sourced from tuna, turkey, ginger, mushrooms, sesame seeds and apricots. This is also a core ingredient of Trioxidil and deficiencies in it have been reported to cause pellagra – a disease that is characterized by dermatitis, alopecia and dementia[4]. Indeed, a study in 2005 showed that topically applied niacin resulted in a statistically significant increase in hair fullness in women with alopecia[5].

Foligain’s product also contains naturally occurring minerals in addition to vitamins. Zinc is an essential mineral which plays a central role in protein synthesis and cellular division and proliferation. Deficiencies in zinc may be brought about by adhering to a strict diet (e.g. veganism) or due to inherited genetic disorders of metabolism. Zinc deficiency has been shown to lead to male pattern hair loss, female pattern hair loss and telogen effluvium. These conditions have been shown to be reversible after the administration of zinc supplementation (frequently oral[6].

The last ingredient in this product – copper, is involved in the function of key enzymes which play a role in the synthesis of melanin and cross-linking of collagen (thyrosinase and lysyl oxidase). Of the six ingredients in Foligain’s product, copper deficiency is the only one which lacks scientific validation for being associated with hair loss. One study in 2013 sought to analyse serum copper and zinc levels in patients with hair loss, and found that although lower copper levels were significantly associated with hair loss, copper concentrations did not display such an association [7]. However, a more recent study  in 2017 showed that copper deficiency was observed in about 30% of participants (men and women with hair loss).[8]. Hence, there could be some merit in including copper in this product.

What products contain Trioxidil?

 A cursory review of Foligain’s website reveals that there are four main products that contain it. These are:

Triple Action Shampoo for Thinning Hair (2%)

• Targeted Shampoo
• Moisture-lock seals in nutrients
• Free of parabens and phthalates

Triple Action Conditioner for Thinning Hair (2%)

• Targeted Conditioner
• Lightweight
• Free of parabens and phthalate

Triple Action Complete Formula (10%) for Thinning Hair

• Topical Spray (once-daily)
• To be used 3-5 times a week
• 10% Trioxidil.

Adanced Hair Regrowth Treatment (5% +5%)

• A blend of 5% Minoxidil and 5% Trioxidil
• Topical Spray (twice-daily)
• To be used daily

 Each of these products is available for both men and women. Foligain recommends using these products together  in order to achieve best results.

Clinical Results

By the time when this blog is written, a search of publicly accessible, open and peer-reviewed scientific databases such as PubMed, Cochrane, Embase and OVID does not reveal any study on this product. This is in contrast to say, Minoxidil, Finasteride or Ketoconazole, for which hundreds of studies are freely available to review their performance and safety. Although the individual ingredients (niacin, Vitamin B6, folate, biotin, zinc and copper) have been shown to either cause hair loss when deficient, or improve hair growth when supplemented, the entire product has not been scientifically validated for its performance and safety in patients with hair loss.

Side-Effects of Trioxidil

Since no studies have been performed using this product, there have been no adverse or serious adverse events reported in the literature. However, that is not to say that the product is completely safe. This is very similar to the L'Oreal's stemoxyline that was said to work as efficient as minoxidil but with zero sided effect. Even though the manufacturers claim that they use a moisture barrier technology to retain the bioactive ingredients, the labels on their four products do state that “if irritation, redness or discomfort occurs, discontinue use and consult a licensed healthcare practitioner”.

A further analysis of the ingredients contained within their four flagship products reveals the use of propylene glycol, glycerin, lecithin, panthenol amongst other emulsifiers, solvents and anti-foaming agents. This means that users of their products are susceptible to allergic reactions, anaphylactoid reactions. Many of these agents are also associated with allergic dermatitis and skin irritation.

Minoxidil - An Alternative for Hair Loss

In view of the limitations of Foligain’s product, two alternatives to hair-loss therapy which have demonstrated superior performance and safety should be considered. The first of these is Minoxidil, a ingredient that was originally developed for the treatment of high blood pressure and carried the interesting side-effect of hair growth[9]. Marketed today as Rogaine or Regaine, this miracle drug is available as an over-the-counter topical solution that can reverse hair loss and even promote facial hair growth for those who lack the genetic or hormonal disposition for a beard or moustache.

Minoxidil works by opening the potassium channels of smooth muscle cells which comprise the arteries supplying hair follicles, causing dilation and improving circulation. Minoxidil’s performance has been widely studied – several studies in the literature have proven its performance in reversing progressive hair loss in central areas of the scalp[10]. In regard to safety, Minoxidil is generally safe and can sometimes cause reddening and itching of the scalp and occasionally palpitations [11. Years of studies have shown that minoxidil is well tolerated and may cause mild skin irritation and some isolated itching. One disadvantage of minoxidil is that it causes “telogen effluvium” which is characterised by some shedding of hair early in its course.

Ketoconazole – An Alternative for Hair Loss

Patients with alopecia who are looking to purchase a therapeutic shampoo for their hair loss should consider better alternatives such as ketoconazole shampoo. Ketoconazole shampoo has been unanimously recognized as a universal treatment for dandruff, seborrheic dermatitis as well as in androgenetic alopecia (male pattern baldness). One landmark study in 1998 showed that 2% ketoconazole shampoo was equivalent to topical minoxidil treatment in promoting the density, size and proportion of hair follicles in patients with male pattern baldness [12].

As the better alternative to Tri-oxidil products, the Hair Covet Hair Restoration Shampoo and the Lipogaine Big 3 Shampoo represent novel solutions for sufferers of male pattern baldness. These shampoos integrate naturally occurring compounds such as biotin, niacin, copper, saw palmetto, black castor oil, caffeine, argon oil and ketoconazole to deliver the best results in terms of hair growth and thickness. These shampoos can be purchased at https://www.minoxidilmax.com/hair-covet-hair-restoration-shampoo and https://www.lipogaine.com/lipogaine-big-3-shampoo/

Conclusion

Trioxidil contains naturally occurring compounds that Foligain claims to promote hair growth. It is a promising mixture of different ingredietnts that may help hair growth. Nonetheless, its safety and performance didn't go through the rigorous studies that  Minoxidil and Ketoconazole did. Without doubt, the latter represent more reliable and cost-effective options in the war against hair loss.

References

1.            Brzezinska-Wcislo, L., [Evaluation of vitamin B6 and calcium pantothenate effectiveness on hair growth from clinical and trichographic aspects for treatment of diffuse alopecia in women]. Wiad Lek, 2001. 54(1-2): p. 11-8.

2.            Guo, E.L. and R. Katta, Diet and hair loss: effects of nutrient deficiency and supplement use. Dermatol Pract Concept, 2017. 7(1): p. 1-10.

3.            Almohanna, H.M., et al., The Role of Vitamins and Minerals in Hair Loss: A Review. Dermatology and Therapy, 2019. 9(1): p. 51-70.

4.            Spivak, J.L. and D.L. Jackson, Pellagra: an analysis of 18 patients and a review of the literature. Johns Hopkins Med J, 1977. 140(6): p. 295-309.

5.            Draelos, Z.D., et al., A pilot study evaluating the efficacy of topically applied niacin derivatives for treatment of female pattern alopecia. J Cosmet Dermatol, 2005. 4(4): p. 258-61.

6.            Karashima, T., et al., Oral zinc therapy for zinc deficiency-related telogen effluvium. Dermatol Ther, 2012. 25(2): p. 210-3.

7.            Kil, M.S., C.W. Kim, and S.S. Kim, Analysis of serum zinc and copper concentrations in hair loss. Ann Dermatol, 2013. 25(4): p. 405-9.

8.            Gowda, D., V. Premalatha, and D.B. Imtiyaz, Prevalence of Nutritional Deficiencies in Hair Loss among Indian Participants: Results of a Cross-sectional Study. Int J Trichology, 2017. 9(3): p. 101-104.

9.            Zappacosta, A.R., Reversal of baldness in patient receiving minoxidil for hypertension. N Engl J Med, 1980. 303(25): p. 1480-1.

10.          Varothai, S. and W.F. Bergfeld, Androgenetic alopecia: an evidence-based treatment update. Am J Clin Dermatol, 2014. 15(3): p. 217-30.

11.          Ingprasert, S., et al., Efficacy and safety of minoxidil 3% lotion for beard enhancement: A randomized, double-masked, placebo-controlled study. J Dermatol, 2016. 43(8): p. 968-9.

12.          Pierard-Franchimont, C., et al., Ketoconazole shampoo: effect of long-term use in androgenic alopecia. Dermatology, 1998. 196(4): p. 474-7.