Dutasteride ineffective for acne??

[Bryan]

Kofi posted this interesting new abstract (below) on alt.baldspot. I'm quite surprised that they found that a specific 5a-reductase type 1 inhibitor (they don't specify in the abstract which one they used, but I wouldn't be surprised if it's Merck's MK386) had no effect on acne, which probably also means that dutasteride wouldn't be very useful, either. Very strange...this study is definitely on my "Get List". I want to read the whole thing. (BTW, note the participation of Sawaya)

J Am Acad Dermatol. 2004 Mar;50(3):443-7

"A systemic type I 5 alpha-reductase inhibitor is ineffective in the treatment of acne vulgaris"

Leyden J, Bergfeld W, Drake L, Dunlap F, Goldman MP, Gottlieb AB, Heffernan MP, Hickman JG, Hordinsky M, Jarrett M, Kang S, Lucky A, Peck G, Phillips T, Rapaport M, Roberts J, Savin R, Sawaya ME, Shalita A, Shavin J, Shaw JC, Stein L, Stewart D, Strauss J, Swinehart J, Swinyer L, Thiboutot D, Washenik K, Weinstein G, Whiting D, Pappas F, Sanchez M, Terranella L, Waldstreicher J.

Excessive sebum production is a central aspect of the pathophysiology of acne vulgaris. Sebaceous gland function is under androgen control and it is hypothesized that dihydrotestosterone is formed by the action of 5 alpha-reductase. Type I is the controlling isoenzyme. This study describes a 3-month, multicenter, randomized, placebo-controlled clinical trial with a potent, selective inhibitor of type I 5 alpha-reductase used alone and in combination with systemic minocycline. Inhibition of type I 5 alpha-reductase was not associated with clinical improvement of acne when used alone and did not enhance the clinical benefit of systemic minocycline. These results indicate the need for further work at the molecular level to better understand the action of androgens on sebaceous gland function.

 

[Bryan]

I posted this same thread on the other hairloss sites, too, and here is a further comment from me on one of them:


Ok, I picked up that study tonight, and I've just read the whole thing! Here are the salient points:

As I suspected, they DID use MK386.

They did NOT measure sebum production, unfortunately.

Here's an interesting passage from the DISCUSSION section in which they seem to acknowledge that inhibiting 5a-reductase appears not to be as effective as castration at inhibiting sebaceous gland function (the obvious question to ponder here is whether or not hair follicles themselves show a similar characteristic as sebaceous glands, and re-opens the old discussion of just how effective dutasteride is, compared to castration):

"The importance of androgen control of sebum production and its role in acne is most clearly seen in castrated men who produce less sebum than healthy men who do not have acne, a situation that the administration of testosterone will reverse. (3, 11)"

(3) Hamilton JB. Male hormone substance: a prime factor in acne. J Clin Endocrinol Metab 1941;1:570-92.

(11) Pochi PE, Strauss JS, Mescon H. Sebum secretion and urinary fractional 17-ketosteroid and total 17-hydroxycorticoid excretion in male castrates. J Invest Dermatol 1962;39:485-9.

Bryan