Antiandrogen therapy in hidradenitis suppurativa: finasteride for females

Abstract

Summary Background Given its widely accepted efficacy, androgen blockade therapy for hidradenitis suppurativa (HS) has become a standard of care. Although much less frequently used than spironolactone, a small number of HS studies have reported finasteride as an alternative treatment for women. In this study, we describe the response to and perception of finasteride therapy in a diverse cohort of women with HS. Aim To describe finasteride therapy in a diverse cohort of female patients with HS. Methods We conducted an institutional review board‐approved retrospective chart review and telephone survey of 20 female patients aged ≥ 18 years with a diagnosis of HS. Finasteride was prescribed by a single provider at a specialized HS centre. Results The mean age of the patients was 34.3 ± 13.5 years. Finasteride was initiated predominantly because of one or more contraindications or poor responsiveness to spironolactone. Most patients interviewed (90%; n = 18) were willing to take finasteride again or continue with therapy if indicated. Of the 20 patients, 10 (50%) reported overall satisfaction with finasteride, while 7 (35%) were neutral and 3 (15%) were dissatisfied. No patient reported worsening disease activity while on finasteride and only one (5%) reported decreased quality of life. When asked about adverse effects of finasteride, 80% (n = 16) reported none, while 20% (n = 4) experienced ≥ 1 of the following: headache, nausea, menstrual irregularities, breast tenderness or reduced libido/sexual function. Conclusions Our study suggests that androgen blockade therapy with finasteride is a safe and effective alternative for female patients with HS who have contraindication(s) or intolerance to spironolactone.

The Role of Hormones in Hidradenitis Suppurativa: A Systematic Review

“…There are some case series that show a positive effect of finasteride in HS [ 25 , 26 , 27 , 28 ]. Finasteride is a competitive inhibitor of steroid 5α-reductase and has an anti-androgenic effect.…”

“…In Germany and the USA, finasteride is approved in a daily dose of 1 mg for androgenic alopecia and 5 mg for benign prostatic hyperplasia [ 30 ]. In all four reports, the patients showed a significant improvement in HS [ 25 , 26 , 27 , 28 ]. Under therapy with finasteride, there was a decrease in frequency and intensity of HS relapses.…”

Systemic nonbiologic treatments for hidradenitis suppurativa

“…All studies on finasteride use in HS showed good tolerability of the drug and clinical improvement in at least half of the patients in the studies 8,56–59 . One study found clinical improvement in a population with 17/20 patients having a contraindication to spironolactone, adverse reaction to spironolactone, or no clinical response to spironolactone, suggesting that finasteride may be helpful when spironolactone either cannot be used or fails to improve HS 57 . One study followed patients after they stopped treatment with finasteride and found rapid relapse of their disease 1 month after stopping treatment but good response to re‐initiation of finasteride after stopping 56 .…”

“…5 All studies on finasteride use in HS showed good tolerability of the drug and clinical improvement in at least half of the patients in the studies. 8,[56][57][58][59] One study found clinical improvement in a population with 17/20 patients having a contraindication to spironolactone, adverse reaction to spironolactone, or no clinical response to spironolactone, suggesting that finasteride may be helpful when spironolactone either cannot be used or fails to improve HS. 57 One study followed patients after they stopped treatment with finasteride and found rapid relapse of their disease 1 month after stopping treatment but good response to re-initiation of finasteride after stopping.…”

“…8,[56][57][58][59] One study found clinical improvement in a population with 17/20 patients having a contraindication to spironolactone, adverse reaction to spironolactone, or no clinical response to spironolactone, suggesting that finasteride may be helpful when spironolactone either cannot be used or fails to improve HS. 57 One study followed patients after they stopped treatment with finasteride and found rapid relapse of their disease 1 month after stopping treatment but good response to re-initiation of finasteride after stopping. 56 Furthermore, one case study of a female with Class II obesity, PCOS, and metabolic syndrome achieved normalization of her anemia, leukocytosis, and hypoalbuminemia with a combination of finasteride, dapsone, metformin, and liraglutide at 6 months of therapy, suggesting combination of finasteride with other therapies may be helpful in controlling lab abnormalities in this phenotype of HS patient.…”