Sir,A 37-year-old woman referred to our clinic complaining of hair loss. On dermatological examination, thinning of the hair on vertex was noticed. Laboratory findings were in normal limits. She was diagnosed as female androgenetic alopecia and decided to perform scalp mesotherapy. Three sessions of multiple intradermal biotin injections were performed by point by point mesotherapy injection technique[1] at 15 days intervals. There were not detected any complications after these biotin mesotherapy sessions. Fourth biotin mesotherapy treatment was performed similar to previous sessions, additionally, immediately after mesotherapy injections, approximately in 10 min, topical %5 minoxidil solution was topically applied with gentle massage. 16 h after the fourth session a firm frontal edema was developed, erythema and pain were not associated to edema [Figure 1]. Frontal edema resolved gradually in 2 days. After 2 weeks, the fifth biotin mesotherapy treatment was performed again without topical application of minoxidil and no complication was detected after the fifth session.
Figure 1
Frontal edema without erythema
Frontal edema without erythemaMinoxidil solution can be used in the treatment of alopecia by topical application or by mesotherapy injection. It is shown that minoxidil enhances hair growth by prolonging the anagen phase and induces new hair growth.[2] It is instructed not to use minoxidil over than 1–2 cc within mesotherapy cocktail because the hypotension can be seen due to excess vasodilatation.[23] The vasodilator effect of minoxidil is well-known, and vasodilatory edema is a well-known side effect of vasodilators.[4] With respect of these knowledges, we comment the reason of frontal edema in this patient is due to the excessive absorption of topical applicated %5 minoxidil after hundreds of mesotherapy injections. Though minoxidil was applicated topically, it was absorpted too much by the pores of injected sites and effected as a locally vasodilator and caused the frontal edema. The previous mesotherapy sessions and the last mesotherapy sessions were not complicated, so we suggest the biotin mesotherapy injection does not have a role in this side effect. In the medical literature, we could not found a reported case describing facial edema due to minoxidil application neither by topically nor by mesotherapy injection. However, in patient forum sites we detected that patients noticed “puffy face” due to topical application of minoxidil solution. We present this case to remind the locally edematous effect of minoxidil solution.
Figure 1