Acne Scar Management: Minoxidil as a Promising Approach or a Mirage?

Atrophic and hypertrophic scars can result from various conditions, such as acne, trauma, and surgery. Minoxidil, a medication used for the treatment of severe hypertension and hair loss, has been explored as a potential treatment for scars. This review aims to evaluate the current evidence regarding the role of minoxidil in the treatment of scars. Previously published reviews have primarily focused on the use of minoxidil in hair loss and have only briefly mentioned its potential use for scars. However, minoxidil may have a beneficial effect as an antifibrotic agent. Several studies have reported reduced collagen accumulation and fibrosis after treatment with minoxidil. The proposed mechanism of action is inhibition of the production of lysyl hydroxylases (LHs), which modify and cross-link proteins by converting lysine to hydroxylysine, making collagen more resistant to degradation. Minoxidil, as an LH inhibitor, has been shown to potentially benefit wound healing and regeneration in vitro by inhibiting the proliferation and migration of fibroblasts. To date, direct studies of the efficacy of minoxidil in treating acne scars have not been conducted; however, its inhibitory effects on fibroblast function and antifibrotic outcomes in some in vivo studies suggest that such use may be considered.