Topical minoxidil and low-dose oral minoxidil in onychodystrophy: A proposed treatment algorithm

Abstract

Onychodystrophy includes diverse nail disorders that may impair function and quality of life. Because nails grow slowly, adjunctive therapies that promote nail growth are of increasing interest. This review examines the evidence for minoxidil in nail growth and nail disorders and proposes a treatment algorithm for its adjunctive use in onychodystrophy. A structured search of PubMed and Google Scholar was conducted on December 10, 2025, using terms related to minoxidil and nails. Records were deduplicated, screened, and appraised by full-text review using the Oxford Centre for Evidence-Based Medicine 2009 levels. A potential adjunctive treatment algorithm is proposed, emphasizing treatment of the underlying nail disorder first. Topical minoxidil (2% or 5% solution or foam, applied once or twice daily to the proximal nail fold) or low-dose oral minoxidil (LDOM; 0.625–2.5 mg/day in females and 1.25–5 mg/day in males) may then be considered, with appropriate monitoring and discontinuation criteria. Safety data for topical use indicate predominantly local irritation, whereas LDOM has been associated with tachycardia, edema, and other systemic adverse effects. Minoxidil may support nail growth through KATP channel-mediated vasodilation and growth factor signaling, with downstream activation of the Wnt/?-catenin pathway.Minoxidil shows potential as an adjunct to support nail growth, but nail-disorder–specific evidence remains limited. Controlled trials are needed to define efficacy, optimal regimens, and safety in onychodystrophy.