What 2024 changed for GPs, dermatologists and aesthetic doctors and nurses: JAK inhibitors for alopecia areata, the MHRA and EMA on finasteride, and new evidence and warnings on minoxidil.
From the editors
This edition looks back at 2024 from the medical consulting room. It is a retrospective, written in 2026 for our Four years in review series. Trichozette was not published in 2024, and nothing here should be read as contemporary advice from that year.
For doctors, nurses and pharmacists working with hair and scalp, 2024 brought both new options and clearer warnings. NICE recommended ritlecitinib for severe alopecia areata, the first medicine it had recommended for the condition. The MHRA issued a Drug Safety Update on finasteride and a patient card for every pack. The EMA opened a review of finasteride and dutasteride. Minoxidil, the most familiar hair medicine of all, gained a new European warning and a notable randomised trial.
This edition does not give doses and is not a substitute for the current product information, NICE guidance or the BAD guideline. Guidance may have moved on since 2024, so always check the latest version before prescribing.
Our aim is to set the year in context and to help medical members work well with the cosmetic and clinical colleagues who so often see these patients first. Every factual claim is sourced at the end.
The Trichollective editorial team
Safety
The MHRA asked prescribers to ask first and monitor throughout, and put a card in every pack. Then the EMA opened its own review.
Photograph Megan Bagshaw / Unsplash
Words by the Trichollective editorial team
Finasteride has been prescribed for male pattern hair loss for decades, and increasingly supplied through online services. In 2024 regulators on both sides of the Channel turned their attention to its psychiatric and sexual side effects.
In its April 2024 Drug Safety Update, the MHRA reminded healthcare professionals that finasteride has been associated with depression, suicidal thoughts and sexual dysfunction, and that patients have reported sexual dysfunction persisting after treatment stopped. The update followed a safety review prompted by patients' concerns that these effects were not widely known. The MHRA had received 426 Yellow Card reports of sexual dysfunction and 281 of depressed mood disorders and suicidal or self-injurious behaviours up to 5 April 2024, across both strengths.
“Patients may not notice changes in their own mood; the people around them often do.
The MHRA also suggested that patients tell friends and family they are taking finasteride, because others may notice mood changes first. That is practical advice worth passing on, especially for patients who obtain the medicine online with little face-to-face contact.
The MHRA noted that the product information already described these risks, but that they were not well known among prescribers and patients. The problem it identified was awareness, not a new signal, which is why the response centred on a reminder and a card rather than a change to the licence.
On 4 October 2024 the European Medicines Agency announced that its Pharmacovigilance Risk Assessment Committee had begun a review of finasteride and dutasteride following concerns about suicidal ideation and behaviour. The review covered both hair-loss and prostate indications. Its outcome lies beyond the end of 2024 and outside this edition.
Test yourself
What did the MHRA's April 2024 update ask prescribers to do before prescribing finasteride?
Sources
Every fact in this edition, and where it came from.
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Next · 2023 · Year in review
2023 in review
The year the rules started to move.