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Table of Contents
CORRESPONDENCE
Year : 2019  |  Volume : 37  |  Issue : 4  |  Page : 237-238

Dual effects of 5α-reductase inhibitor dutasteride on androgenetic alopecia and acne vulgaris


1 Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
2 Kito Dermatology Clinic, Hamamatsu, Japan
3 Department of Dermatology, Enshu Hospital, Hamamatsu, Japan

Date of Web Publication17-Dec-2019

Correspondence Address:
Dr. Taisuke Ito
1-20-1 Handayama 431-3192, Higashi-ku
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ds.ds_11_19

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How to cite this article:
Ito T, Kito Y, Masuda Y, Kageyama R, Tokura Y. Dual effects of 5α-reductase inhibitor dutasteride on androgenetic alopecia and acne vulgaris. Dermatol Sin 2019;37:237-8

How to cite this URL:
Ito T, Kito Y, Masuda Y, Kageyama R, Tokura Y. Dual effects of 5α-reductase inhibitor dutasteride on androgenetic alopecia and acne vulgaris. Dermatol Sin [serial online] 2019 [cited 2020 Jul 10];37:237-8. Available from: http://www.dermsinica.org/text.asp?2019/37/4/237/273094



Dear Editor,

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit, resulting from androgen-induced production of sebum, disordered keratinization of hair follicles, colonization of Cutibacterium acnes, and subsequent inflammation.[1] The treatment targets of acne vulgaris that have been mainly exploited are keratinized hair follicles and colonized bacteria, which are treated with topical benzoyl peroxide, oral retinoids, and oral/topical antibiotics.[2] Hormonal antiandrogen therapies, including cyproterone acetate, chlormadinone acetate, and ethinylestradiol, are effective for female patients.[2]

In acne vulgaris, excessive secretion of sebum from sebaceous glands is accelerated by conversion of testosterone to dihydrotestosterone (DHT) by type I 5α reductase that is strongly expressed on sebaceous glands.[3] Therefore, inhibitory reagents of type I 5α-reductase have a potential to improve acne vulgaris. Type I 5 α reductase inhibitor (compound A, 25 mg once daily) has been used for the patient with acne vulgaris.[4] In this study, selective type I inhibitor “compound A (25 mg/day)” was ineffective in the treatment of acne vulgaris. However, it might be different from dutasteride because the applied dose was very different between compound A (25 mg/day) and dutasteride (0.5 mg/day). Dutasteride is a potent type I 5α-reductase inhibitor that has recently been approved for the treatment of androgenetic alopecia (AGA) and benign prostatic hyperplasia (BPH).[5] In the pathogenesis of AGA and BPH, DHT is a key androgen, which is downregulated by dutasteride. Here, we show two AGA patients treated with dutasteride. It is noted that dutasteride also exerted a beneficial therapeutic effect on their concomitant acne vulgaris.


  Case Reports Top


Case 1

A 26-year-old man was referred to our outpatient clinic for hair loss at the vertex of his scalp. He also had small microcomedones, pustules, and papules on his forehead [Figure 1]a (classification of acne severity: moderate).[6] The patient was diagnosed as having AGA by dermoscopic observation with peripilar sign and >20% hair diameter diversity.[7] In addition, he suffered from acne vulgaris. Then, he was treated with dutasteride (0.5 mg/day) for his AGA without any antibiotics and anti-acne cream. Three months later, he noticed improvement of his acne [Figure 1]b (classification of acne severity: mild), although the hair loss was not sufficiently alleviated in this short therapeutic period. Six months after initiation of dutasteride, his hairs regrew with continuously improved acne vulgaris.
Figure 1: Clinical course of patients with AGA and acne vulgaris. (a) Acne vulgaris on the face of case 1 before treatment with dutasteride. Classification of acne severity is moderate. (b) Improvement of acne vulgaris on the face 3 months after treatment with dutasteride. Classification of acne severity is mild. (c) Dermoscopic picture of patient 1 before treatment with dutasteride. Red circles indicate vellus hairs of androgenetic alopecia. Arrows indicate peripilar sign. (d) Acne vulgaris on the face of case 2 before treatment with dutasteride. Classification of acne severity is moderate. (e) Dermoscopic picture of patient 2 after treatment with dutasteride. Red circles indicate vellus hairs of androgenetic alopecia. Arrows indicate peripilar sign. (f) Acne vulgaris on the face of case 2 after treatment with dutasteride. Classification of acne severity is mild

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Case 2

A 23-year-old man was referred to our outpatient clinic for hair loss at the vertex and frontal scalp region in early stage (vertex type I). Dermoscopic observation revealed peripilar sign (arrow), and >20% hair diameter diversity was observed in the hair loss lesion (red circle) [Figure 1]c. Since he also had small papules on his face [Figure 1]d (classification of acne severity: moderate), he was diagnosed as having AGA and acne vulgaris and was treated with dutasteride (0.5 mg/day) for his hair loss without any antibiotics and anti-acne cream. Five months later, remarkable improvement was observed not only in the hair loss [Figure 1]e but also in the facial acne [Figure 1]f (classification of acne severity: mild), although global changes of hair loss was very faint. Dermoscopic observation provided evidence for reduction of vellus hair number after treatment with dutasteride.

Dutasteride inhibits both type I and type II 5α-reductase enzymes. It is approximately 100 times and 3 times more potent than finasteride in the activity to inhibit the type I and II 5α-reductase isoenzymes, respectively.[8] Dutasteride can also decrease serum DHT by >90%.[8] BPH is associated with hyperplasia of both the stromal and epithelial compartments of the prostate gland. Because dermal papillae mainly express type II 5α - reductase, type I 5α - reductase is not a target for AGA treatment. In our cases, it seems that dutasteride improved AGA and acne vulgaris by inhibiting type II and type I 5α - reductase, respectively. In this respect, dutasteride could be a novel option for the treatment of male patients with both AGA and acne vulgaris. It should be kept in mind not to treat acne vulgaris with dutasteride or finasteride in female patients, especially before menopause.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest



 
  References Top

1.
Williams HC, Dellavalle RP, Garner S. Acne vulgaris. Lancet 2012;379:361-72.  Back to cited text no. 1
    
2.
Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol 2016;74:945-73.  Back to cited text no. 2
    
3.
Bayne EK, Flanagan J, Einstein M, Ayala J, Chang B, Azzolina B, et al. Immunohistochemical localization of types 1 and 2 5alpha-reductase in human scalp. Br J Dermatol 1999;141:481-91.  Back to cited text no. 3
    
4.
Leyden J, Bergfeld W, Drake L, Dunlap F, Goldman MP, Gottlieb AB, et al. A systemic type I 5 alpha-reductase inhibitor is ineffective in the treatment of acne vulgaris. J Am Acad Dermatol 2004;50:443-7.  Back to cited text no. 4
    
5.
Gubelin Harcha W, Barboza Martínez J, Tsai TF, Katsuoka K, Kawashima M, Tsuboi R, et al. A randomized, active- and placebo-controlled study of the efficacy and safety of different doses of dutasteride versus placebo and finasteride in the treatment of male subjects with androgenetic alopecia. J Am Acad Dermatol 2014;70:489-98.  Back to cited text no. 5
    
6.
Hayashi N, Akamatsu H, Kawashima M; Acne Study Group. Establishment of grading criteria for acne severity. J Dermatol 2008;35:255-60.  Back to cited text no. 6
    
7.
Inui S, Nakajima T, Itami S. Scalp dermoscopy of androgenetic alopecia in Asian people. J Dermatol 2009;36:82-5.  Back to cited text no. 7
    
8.
Clark RV, Hermann DJ, Cunningham GR, Wilson TH, Morrill BB, Hobbs S, et al. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5alpha-reductase inhibitor. J Clin Endocrinol Metab 2004;89:2179-84.  Back to cited text no. 8
    


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