Prescribing Finasteride for Treating Acne

Hello Mr.Rassman. I know your main profession is regarding the hair and scalp, but I have a question regarding finasteride and acne. you seem to be an expert on finasteride. Studies say dht also causes acne. Finasteride inhibits dht, so can someone with acne benefit by taking finasteride. I found a website that states that in europe, the dermatologists prescribe finasteride for acne.

Here is the link. read under 5-alpha reductase inhibitors:
“A recent development in anti-androgen acne treatment is the inhibition of androgen-metabolizing enzymes in the skin or in the sebaceous glands themselves. One such androgen-metabolizing enzyme is the 5-alpha reductase inhibitor finasteride, which metabolizes testosterone into 5-alpha-testosterone in androgen-regulated target tissues. This enzyme exists in its two isoforms. The Type I isoform mainly occurs in the skin, located in the sebocytes, epidermal and follicular keratinocytes. Antagonists that bind selectively to this Type I isoform includes finasteride and dutasteride, and are believed to be capable of treating acne. European dermatologists have been using finasteride (used in combination with oral contraceptives for female patients) to treat acne, and have received effective results. Such an approach is yet to be approved for use in North America.”

since this method is not approved yet here in North america, what is your opinion on this?

Acne is a problem in the production of sebum and infections that get established in the glands of the hair follicle. If I am not mistaken, there is a bit of error in your quote: Finasteride (which is a 5-alpha reductase inhibitor) inhibits mostly the Type II isoform of DHT. I’m not an expert on acne, but I believe it is the Type I isoform of DHT that is partially responsible for acne. That said, I’ve read that DHT inhibitors can in theory treat acne, though theory does not always work out in real life.

I am not aware of a particular dermatologist in the U.S. that prescribes finasteride as an acne treatment, but I have read of such practice. As you know, finasteride is not approved by the FDA for the treatment of acne… but I don’t think it’ll be approved for that purpose, as the costs for the studies likely aren’t worth it to Merck. Honestly though, I get disproportionate emails from people on the Internet who are scared of using finasteride for male pattern hair loss despite its efficacy and safety profile. It takes real work for me to actually educate each and every patient on the real side effect and dispel Internet myths. If indeed finasteride can help with acne, good luck with the other swarm of myths to follow.