Drug-Induced Liver Failure Following Topical Minoxidil: A Case Report

Drug-induced liver failure (DILI) is one of the causes of acute liver injury (13%-20%), encompassing both predictable and idiosyncratic reactions. While the latter are rare, it can lead to severe liver damage in vulnerable patients. Although topical minoxidil is a widely used treatment for androgenetic alopecia, cases of liver failure linked to its use are extremely uncommon and have not been widely described. This case report discusses the potential for severe liver injury following topical minoxidil application.

A 21-year-old female with no significant medical history presented with jaundice, elevated liver enzymes, and impaired liver function three and a half weeks after starting topical minoxidil for alopecia areata. Laboratory tests revealed significantly elevated transaminases, bilirubin, and disturbed coagulation. A liver biopsy revealed centrilobular necrosis, which indicated drug-induced liver damage. After discontinuation of minoxidil, the patient's condition improved rapidly, with a marked decrease in liver enzymes and disappearance of clinical symptoms.

This is the first evidence of severe drug-induced liver failure associated with topical minoxidil. It underscores the potential for hepatotoxicity even with over-the-counter drugs that are thought to have minimal systemic absorption. The rapid improvement after discontinuation of the drug and exclusion of differential diagnoses suggests a causal relationship. In cases of severe liver failure of unclear origin, all substances should be considered in the case history.