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HORMONES AND ANTIANDROGENS

Oral contraceptive pills often have a beneficial effect on acne and related disorders, especially if premenstrual flare is apparent.

    Antiandrogens have several uses in dermatology. Cyproterone acetate, used in conjunction with an oral contraceptive (either in low dose as a combined preparation, co-cyprindiol, or in higher dose by using the two separately) has a role in treatment of acne, hidradenitis suppurativa (Fig.4.7), hirsuties, and other androgen-related disorders. It inhibits binding of testosterone to receptors and also acts as an antigonadotropin, leading to decreased testosterone production.

Figure 4.7  Hidradenitis suppurativa of the axilla. This condition, discussed in Chapter 10, may respond to long-term antibiotics along the same lines as their use in acne; in some patients, there is a clear hormonal influence, manifest as a tendency for premenstrual exacerbation or by a response to antiandrogen therapy.

    Finasteride is used in male alopecia; it blocks conversion of testosterone to dihydrotestosterone by inhibiting the enzyme 5- a -reductase. It is contraindicated in premenopausal women and ineffective for alopecia in postmenopausal women.

    Less commonly used drugs for androgenic disorders include flutamide and spironolactone. Their lower level of popularity is because flutamide may cause hepatotoxicity, while spironolactone may cause menstrual abnormalities and electrolyte disturbances, and has been linked with a carcinogenesis risk in animal studies. There is increasing interest in use of metformin for hirsuties and androgenic disorders.

White/Cox: Diseases of the Skin, 2ed.(c) 2006, Elsevier Inc. All rights reserved.